# Two cases of misleading Epstein-Barr virus infection and the role of EBV-DNA

## TL;DR

This paper presents two unusual cases of Epstein-Barr virus infection that were initially misdiagnosed due to negative serology, highlighting the importance of EBV-DNA testing for accurate diagnosis.

## Contribution

The paper emphasizes the role of EBV-DNA testing in diagnosing EBV infection when serology is misleading.

## Key findings

- Two teenagers with atypical EBV infections had initially negative serology but tested positive for EBV-DNA.
- PET/CT scans in one case showed lymphoma-like features, but EBV-DNA testing confirmed EBV infection.
- EBV-DNA testing is recommended early in the diagnostic process to avoid unnecessary investigations.

## Abstract

Two atypical cases of infectious mononucleosis in two teenagers with initially negative serology and non-evocative blood examinations are reported. The first patient had recently traveled to Africa, and Epstein-Barr virus negative serology led us to make many extensive investigations. The second patient complained of asthenia for a month, and PET/CT was performed to suspicion of lymphoma. PET scan revealed hypermetabolic lymph nodes in the supradiaphragmatic and subdiaphragmatic stations, along with18F-FDG uptake in the spleen and pharynx, raising more suspicion of lymphoma. Fortunately, Epstein-Barr virus DNA testing was performed and turned positive in both cases, and Epstein-Barr virus serology subsequently became positive. Diagnosing EBV infection can be challenging in rare cases, as EBV-specific serology may be negative in the early stages and confounding factors may be present. Therefore, Epstein-Barr virus DNA testing should be considered early in the diagnostic algorithm to prevent unnecessary investigations in similar cases.