Cytomegalovirus mononucleosis as a cause of prolonged fever and prominent weight loss in immunocompetent adults

Abstract

Four immunocompetent adults presented with protracted fever lasting > 6 weeks and severe weight loss, associated with primary cytomegalovirus (CMV) infection. Each patient had spleen enlargement, lymphocytosis and hypertriglyceridaemia, but recovered spontaneously. A further 20 immunocompetent patients with primary CMV infection were also reviewed, and all presented the usual clinical picture of CMV mononucleosis. It was concluded that CMV mononucleosis should be considered in the differential diagnosis in patients with prolonged fever and weight loss if lymphocytosis is present.

Primary Cytomegalovirus Infection in Otherwise Healthy Adults with Fever of Unknown Origin: A 3-Year Prospective Survey

“…The increased availability of serology-biomolecular assays, which support a prompt recognition and monitoring of acute-relapsing cytomegalovirus infection which may complicate immunodeficiency [4,6,7,13,14], have allowed physicians to add these assays to the workup of FUO. As a result, an apparent rise of these diagnoses during unexplained viral diseases or FUO have been observed [11,18,20], and also studies performed in sexually transmitted disease clinics confirmed this tendency [21,22]. Eighty-one cases of primary cytomegalovirus infection in immunocompetent hosts were retrospectively reviewed [18], but laboratory examinations did not remain consistent during the 10-year period.…”

“…However, the incidence of mononucleosis-like syndrome and organ involvement by primary cytomegalovirus infection tested lower in frequency, when compared with other experiences [16] and our survey. From Spain, four immunocompetent adults were described with primary cytomegalovirus disease expressing with fever lasting over 6 weeks, a mononucleosis-like syndrome, weight loss, and lymphocytosis [20].…”

“…In addition, some pilot studies have been conducted on congenital-perinatal infection [6,[8][9][10], and we have specifically updated diagnostic, monitoring, therapeutic and prophylaxis guidelines for immunocompromised, at-risk subjects [7,11,14] On the other hand, antiviral treatment is not indicated in immunocompetent patients, where a self-limiting course is expected [6,7,14,16,17,20,23]. However, some attempt of antiviral therapy was reported during primary, long-lasting cytomegalovirus disease in immunocompetent individuals [20,23]. From a diagnostic point of view, clinicians (and especially practitioners, who first face patients with FUO) [1,2,6,11,20] should maintain an elevated suspicion for primary cytomegalovirus infection during the workup for suspected FUO.…”

“…However, some attempt of antiviral therapy was reported during primary, long-lasting cytomegalovirus disease in immunocompetent individuals [20,23]. From a diagnostic point of view, clinicians (and especially practitioners, who first face patients with FUO) [1,2,6,11,20] should maintain an elevated suspicion for primary cytomegalovirus infection during the workup for suspected FUO. In our experience, the diagnosis was reached only 3-11 weeks after disease onset, based on combined virologic and serologic assays.…”

Human Cytomegalovirus Infection Among Neonates With Symptomatic Congenital Infections and Birth Defects

“…Fever for unknown reasons was shown in 12% of symptomatic HCMV infected neonates. Fever for unknown reasons may indicate the prenatal HCMV infection among neonates in this study since it presents the usual clinical picture of HCMV mononucleosis among immunocompetent children (42) . Heart diseases and feeding difficulties were last regarding the order of frequency.…”