Department of Internal Medicine, Bridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut, USA.
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
BMJ Case Rep. 2023 May 3;16(5):e250081. doi: 10.1136/bcr-2022-250081.
The heterophile antibody (also known as the Monospot) test is a useful screening tool for infectious mononucleosis (IM) resulting from primary Epstein-Barr virus (EBV) infection. However, up to 10% of patients with IM are heterophile negative. Heterophile-negative patients who have lymphocytosis or atypical lymphocytes on peripheral blood smear should be further tested for EBV serologies, which include testing for specific IgM and IgG antibodies against viral capsid antigens, early antigens and EBV nuclear antigen proteins. A diagnostic dilemma arises when the patient has clinical and laboratory features of IM, but is both heterophile negative and seronegative for IM, as illustrated in this case presentation. To avoid missed diagnoses of IM, misdiagnosis of mononucleosis-like illnesses and unnecessary testing, knowledge of test characteristics and the evolving course of EBV serologies is important to assure and inform both the physician and the patient.
嗜异性抗体（也称为单克隆抗体）检测是一种有用的筛查工具，可用于检测由原发性 EBV 感染引起的传染性单核细胞增多症（IM）。然而，多达 10%的 IM 患者嗜异性抗体阴性。对于外周血涂片显示淋巴细胞增多或异型淋巴细胞的嗜异性抗体阴性患者，应进一步进行 EBV 血清学检查，包括针对病毒衣壳抗原、早期抗原和 EBV 核抗原蛋白的特异性 IgM 和 IgG 抗体检测。当患者具有 IM 的临床和实验室特征，但嗜异性抗体和 IM 的血清学检测均为阴性时，就会出现诊断难题，如本病例所述。为避免漏诊 IM、误诊类单核细胞增多症样疾病和不必要的检测，了解检测特征和 EBV 血清学的演变过程对于确保医生和患者都能获得并了解相关信息非常重要。
