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Epstein-Barr IgM positive, PCR negative. Chronic fatigue?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hi doctor,

I have had reactivated Epstein-Barr for a year. I recently got a blood test, which said, faint monoclonal band detected in the gamma region, repeat blood test in six months. There is no immunoparesis, and my levels have risen in the last four months, but still in the normal range. What does this mean? Could this be transient due to an infection? The IgM remains positive, the PCR undetectable, but I am still sick. Could it be chronic fatigue?

I have had a similar experience recently with positive IgM for Cytomegalovirus, but undetectable PCR. And even one positive for Lymes and another negative. Could it be cross-reacting antibodies or something more sinister? I am currently taking Cipralex and Risperdal.

Answered by Dr. Shinas Hussain A. P

Hello,

Welcome to icliniq.com.

I have gone through your query, and I can understand your concerns.

  1. The brief history you have described suggest a possibility of past infection with EBV (Ebstein-Barr virus). Probably you had an episode of IMN( infectious mononucleosis) in the childhood, which is quite common in the developing world.
  2. EBV remains dormant in few cells and blood for a long time and probably for lifelong. And it can cause reactivation as in your case. Serological will be positive lifelong due to the dormant virus in the blood.
  3. Fatigue, malaise and a headache are quite common with reactivated EBV infection, and you do not need to worry regarding this.
  4. Patients with chronic fatigue syndrome may have high titers of antibody to EBV, but not different from healthy EBV-positive individuals. Persistent EBV infection is not a cause of chronic fatigue syndrome.
  5. A heterophile antibody test is a confirmatory test for EBV. Cross-reactivity with CMV (Cytomegalovirus) is very common because both contain similar components on their surface. It might be the reason for false positive CMV in your case. False positive results are also obtained with connective tissue diseases, malaria, and viral hepatitis. You can go for VCA (viral antigen assay) which is more specific.
  6. The high rate of monoclonal gammopathy is common with EBV infection, and it will revert to normal in three or four weeks.
  7. If you noticed any swollen lymph node especially around your neck area, a biopsy might be needed to rule out Hodgkin's lymphoma, which can arise out of EBV infection.

I suggest you consult a general physician with special interest in infectious disease, for a detailed evaluation.

I hope I have answered your query. Please feel free to contact if you have any further queries.

Patient's Query

Hi doctor,

Thank you for this information.

The EBV reactivated after bronchitis a year ago, and treatment with cortisone was done. The IgM antibodies are still positive a year later. However, the PCR is undetectable. I was also tested positive on one Lymes antibodies test and negative on western blot. Could this also be cross reacting antibodies? The problem is that it is one year and one month, and I am still very sick although the PCR for EBV is undetectable. The faint monoclonal band in the gamma region was only detected a few days ago. So, how will it go away in three to four weeks, when I have been sick for over a year? I have fatigue, brain fog, feel off balance to the left, body aches, and some tinnitus. The EBV made me very sick, and I have had an endless list of symptoms since it started, some of which have changed over time.

Answered by Dr. Shinas Hussain A. P

Hi,

Welcome back to icliniq.com.

  1. Do not worry regarding antibody test, and it may remain positive lifelong.
  2. Positive Lyme antibody could be due to mere cross-reactivity. No need to worry as long as you do not have any symptoms suggestive of Lyme disease.
  3. Your faint monoclonal band is also normal finding in your case and is not at all important.
  4. The fatigue and malaise need to be evaluated thoroughly. We have to rule out some diseases like diabetes, Addison's disease, Cushing's disease, hematologic diseases like leukemia and lymphomas, etc.
  5. The other possibility is anxiety. Consult a physician and get evaluated, you have to do a series of blood investigation, and the bone marrow also has to be ruled out of any malignancies.

Patient's Query

Hi doctor,

Thank you for replying. Are you saying that the active IgM can remain positive? I thought that the IgM go away, and IgG remained lifelong. With regards to the faint monoclonal band in the gamma region, please explain in more detail why it is nothing to worry about? I read that cancer and related to this. The EBV definitely causes my symptoms, but can it last this long? It seems to have triggered chronic fatigue syndrome or something.

Answered by Dr. Shinas Hussain A. P

Hi,

Welcome back to icliniq.com.

Since you are so concerned, I will try to explain elaborately.

  1. About IgM and IgG: Antibodies against viral antigen can remain positive lifelong. But the pattern is inconsistent, as you said IgM appear first and goes away after few months but IgG persists for life. Generally, after an acute infection or on a reactivation, IgM appear first elevated during 4 to 5 months. You got a positive IgM after one year may be due to minor undetected reactivation or other mild infection caused cross-reactivity. To confirm the EBV, we have to do a VCA or EBNA (Epstein-Barr nuclear antigen).
  2. About the faint monoclonal band: It is quite common for EBV infection and does not signify any disease. You have to do a peripheral smear and bone marrow test to rule out conditions like hematological malignancies like leukemia, lymphoma, and multiple myeloma. MGUS (monoclonal gammopathy of undetermined significance) is a harmless condition, and no treatment is required, but annual protein electrophoresis may be needed.
  3. About symptoms and fatigue: Patients with chronic fatigue syndrome (CFS) may show positive results with EBV. It might be the reason for your test results. EBV-infected patients can present with similar symptoms as you have mentioned, but a year duration is quite long and very unlikely. So we have to rule out CFS first by a set of guidelines. There is no test to confirm CFS.

I suggest you consult a general physician for detailed evaluation. If EBV causes it, it will go away by the end of six months with supportive measures.

Patient's Query

Hello doctor,

Thank you. So in my case, the monoclonal band could go away on its own and not be of any clinical significance besides due to the infection? And further testing would just be precautionary?

Answered by Dr. Shinas Hussain A. P

Hi,

Welcome back to icliniq.com.

Exactly, annual follow-up with electrophoresis would be better. Consult hemato-oncologist for expert opinion

Patient's Query

Hi doctor,

Thank you for replying. The PCR is constantly undetectable for EBV, but as I said the IgM is positive. So, could it be a smoldering undetectable viral count? One of my symptoms is dizziness, and I lose my balance. This all happened after the Cortisone and bronchitis. If the virus has only finally gone now a year later but has triggered CFS, you say I can recover with support in 6 more months? What kind of support is needed?

Answered by Dr. Shinas Hussain A. P

Hello,

Welcome back to icliniq.com.

Yes, the positive IgM just indicates a minor reactivation.

The other possibility is chronic fatigue syndrome. Some patients with CFS show laboratory findings as in EBV infection. It might be a possible reason for positive IgM. It does not mean that the EBV had triggered CFS. CFS is not synonymous with chronic EBV infection or chronic infectious mononucleosis.

Unfortunately, there is no definitive treatment for both EBV and CFS. We have only supportive therapy for it. That is what I meant by support.

You can go for the following supportive measures.

  1. Cognitive behavioral therapy and counseling.
  2. A healthy diet and adequate sleep.
  3. Avoid use of any recreational drugs if you have a habit of it.
  4. Antidepressants may be needed in some cases.
  5. Consult a general physician and get evaluated for CFS.

The thing you should have a serious look is the increased risk of hematological malignancies in EBV-infected patients. So, if you feel a swollen lymph node in your neck kindly get evaluated.

Patient's Query

Hi doctor,

Thank you, I am anxious about the faint monoclonal band. Would this go together with a rise in antibodies? What does this signify? Is it cancer?

Answered by Dr. Shinas Hussain A. P

Hi,

Welcome back to icliniq.com.

  1. The faint monoclonal band is quite normal in EBV. It does not cause any harm.
  2. Another possibility is MGUS, it is also a harmless condition, and no treatment is required, only yearly electrophoresis is recommended.

You can go for bone marrow tests to rule out cancers like multiple myeloma.

Answered byDr. Shinas Hussain A. P

Medically reviewed byiCliniq medical review team

Published At May 25, 2017
Reviewed AtJune 5, 2024

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Shinas Hussain A. P
Dr. Shinas Hussain A. P

General Practitioner

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