Case 121

1. Prepared by Curtis Gravenmier MD and reviewed by Heba Mostafa MBBCh, PhD, D(ABMM)

An HIV-positive adult with absolute CD3+CD4+ lymphocyte count of 400 is brought to the hospital with fever, somnolence, and both stool and urine incontinence. The initial evaluation is remarkable for tachycardia, hypotension, and granulocytosis with left shift. A chest x-ray shows patchy opacities in the right upper lobe and bilateral lung bases, and a Streptococcus pneumoniae urine antigen test is positive. The patient responds well to fluid resuscitation and empiric therapy for bacterial pneumonia. Altered mental status persists, however, prompting lumbar puncture. The cerebrospinal fluid shows a lymphocytic pleocytosis, elevated total protein, and Epstein-Barr virus DNA is detected using qualitative real-time PCR. Spinal fluid cultures and a cryptococcal antigen test are negative.


Which of the following is incorrect regarding Epstein-Barr virus (EBV)?