Brief Answer: Autoimmune disease is a strong possibility Detailed Answer: Hi there, Thanks for your queries. The answers to your queries are as follows :- 1. (a) EBV is apparently neither responsible for your symptoms, nor low Platelet count. (b) However, there is evidence that infection with the EBV is associated with a higher risk of certain autoimmune diseases, especially Dermatomyositis, systemic lupus Erythematosus, rheumatoid arthritis, Sjögren's syndrome, mixed connective tissue disease (MCTD) and multiple sclerosis. (c) High ANA titers indicate presence of an autoimmune disease. Your symptoms, though inadequately described, are suggestive of an autoimmune disease, most likely MCTD. Consult a rheumatologist, who will order for more specific antibodies' test to pinpoint the disorder and advise you the specific treatment. 2. Your wife's skin condition is not likely due to EBV. It may either have a different etiology or, as in your case, an autoimmune disease (SLE or Dermatomyositis). 3. The HIV tests done, which are very sensitive and specific, have ruled out HIV conclusively. 4. Home HIV test- if negative at 6 and 12 months- rules out HIV. 5. There is no correlation between EBV, ANA and HIV 6. Newly detected allergies are unlikely to cause your symptoms particularly gut, provided you have been avoiding crabs and corn and their products. Consult your doctor and apprise him of my opinion. I am certain that he will agree with me; order required tests, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment as advised. Hope I have addressed your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards, Col (Dr.) Rakesh Karanwal

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Brief Answer: Need to explore other possibilities Detailed Answer: Hi, Firstly, sorry for the delay in response, due to different Time Zones. I can fully understand your concerns, frustration and helplessness. 1. We have run out of options as all tests for autoimmune diseases have been carried out by rheumatologist and found to be negative. However, Polymyositis has not been ruled out by him. Also, your symptoms indicate possibility of rheumatoid arthritis, for which the Anti-CCP test (diagnostic test) has apparently not been done. 2. Chronic MILD EBV Infection (in view of a persistently low platelet counts)- though remote- is a possibility which cannot be wished away. Incidentally, the symptoms of chronic active EBV infection include fever, liver dysfunction, enlarged spleen (heaviness or lump felt in left upper abdomen), enlarged lymph nodes (lumps in armpits, neck and other regions), anemia, rash, oral ulcers, to name a few. However, almost 95% of the US population get EBV infection by around 40 years of age. Hence, a positive EBV test do not necessarily indicate chronic EBV infection. PLEASE UPLOAD YOUR EBV TEST REPORTS (old and recent) for my perusal. A turnaround in the Platelet counts is a good sign, which apparently signifies gradual improvement. Test for Platelet counts at regular intervals in future, would provide us with the prognosis. 3. Allergy to corn and crabs commonly begins/occurs in your age group. It has nothing to do with either, EBV infection or, low platelet count. Further, though abdominal pain is a symptom found in EBV infection, it is apparently due to crab/corn allergies (abdominal pain with diarrhoea and vomiting that you had sometime back). 4. Therefore, since EBV-induced auto immune disease have been ruled out, other causes- as listed below- of your problems have to looked into/considered. * Apart from autoimmune disease, EBV infection can also cause Chronic fatigue syndrome, the symptoms of which are severe chronic fatigue , impaired memory or concentration, muscles pain (in your case, neck muscles), sore throat, joints-pain (hands, shoulder as in your case), headaches, disturbed sleep. Incidentally, do you have tender lymph nodes in neck or armpits? * Fibromyalgia, the symptoms of which are similar to those of Chronic Fatigue Syndrome. In addition, there may also be anxiety, depression, and disturbances in bowel function. * Planter fasciitis, in which there is inflammation of the protective sheath in the soles of feet, which causes persistent pain in the soles, particularly during sleep and prolonged rest. * Stress fractures of the feet's bones due to osteoporosis, following vitamin D deficiency. 5. Lastly, effective treatment will depend on the specific diagnosis, by excluding the possible above-mentioned causes. This notwithstanding, I feel that COMBINATION of a course of :- - anti-inflammatory drugs, - an anti-depressant drug (belonging to a Tricyclic group), such as, amitriptyline along with Fluoxetine; or, Duloxetine - Vitamin D3 (Calcitriol) 0.5mcg with at least 1000mg of calcium should give you substantial relief. However, your doctor is the BEST JUDGE. You may therefore, consult your doctor again and apprise him of the possibilities given by me. He is expected to actively consider my opinion and proceed to short-list the exact cause by way of exclusion. Take care

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