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Is There Any Relationship Between CFS And EBV Infection?

Posted on Mon, 23 Nov 2015

Question: After being mostly bedridden since last February because of a thoracic back injury, I was treated with a rhizotomy, which appears to have worked (most of the time). The next step was to discontinue the Duragesic patch (12 mcg/72'), after 14 years of use. The pain mgmt doc failed to do this slowly. However, I continue to take Norco (10-325 mg) 4 times a day. I've found if I don't take it regularly (less than three times a day), I feel ill. I'm not craving it. In fact, I will forget about it until I begin to feel nauseaus and groggy.

I was tested a month ago for several viruses by the Urgent Care doctor I saw after having a bad interaction (Requip, Norco, and Tenazadine). And, while I am not active for these (EBV, CMV, HHV-6), I had an extremely high IgG for EBV (270 versus the positive range of >21). I am aware that 90 percent of the population has had these viruses at one time or another; however, because of the amount of antibodies in my bloodstream, could I still be having symptoms of EBV? I am trying to be more active, but I'm not doing very well, feeling like I have a case of the flu magnified, each time I attempt even the mildest of exercise (like trick-or-treating with my grandkids Saturday night). I awoke the next morning with a migraine headache. I slept all day Monday... just now regaining my strength today. Could this be CFS?

Answered by Dr. Tushar Kanti Biswas (7 hours later)

Brief Answer:
?CFS ?Chronic active EBV infection

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

Patients with chronic fatigue syndrome (CFS) may have titers of antibody
to EBV that are elevated but are not significantly different from those
in healthy EBV-seropositive adults. While some patients have malaise
and fatigue that persist for weeks or months after IM, persistent EBV
infection is not a cause of chronic fatigue syndrome.

So it is unlikely you are having CFS.

Chronic active EBV infection is very rare and is distinct from chronic fatigue syndrome.The affected patients have an illness lasting >6 months, with
elevated levels of EBV DNA in the blood, high titers of antibody to
EBV, and evidence of organ involvement, including hepatosplenomegaly,
lymphadenopathy, and pneumonitis, uveitis, or neurologic disease.

Since you don't have any organ involvement ,Chronic active EBV infection is also not a possibility.
However you can go for EBV DNA -PCR( polymerase chain reaction )as IgG antibody for EBV is high .
IgG antibody is often used to assess past exposure to EBV because it persists for life.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Tushar Kanti Biswas (2 days later)

Actually, there does appear to be some organ involvement. I'm in stage one liver failure, stage one kidney failure, and recently, a borderline ekg that is being followed by a cardiologist. After suffering an arrhythmia that nearly made me faint while being evaluated by a personal trainer at my local gym, my activity is restricted until I see him on the 17th. And, three years ago I had what appeared to be a stroke with severe malaise and lethargy. After the initial episode, it took me over three months to regain my energy level and almost a year to regain full cognitive functioning. I was forced to quit school with only one class remaining in the program. It took over six months for the left side of my face to return to normal.

I apologize for not providing you a more detailed history in order to produce a more accurate diagnosis. I was trying to keep things simple. I guess there's nothing simple about it. Is it possible that all of this could be related?

Answered by Dr. Tushar Kanti Biswas (1 hour later)

Brief Answer:
?Chronic active EBV infection

Detailed Answer:
In view of organ involvement liver and renal failure and stroke (neurological involvement) and high IgG titre for EBV (270 versus the positive range of >21),
Chronic active EBV infection is likely and it often mimics chronic fatigue syndrome.The diagnosis will be substantiated by elevated levels of EBV DNA in the blood ( as suggested already to undergo the PCR test).
Except for cardiac arrhythmia,all other features could be explained by Chronic active EBV infection.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

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Above answer was peer-reviewed by : Dr. Sonia Raina