Acute Systemic Viral Infection Masquerading as an Infiltrating Lymphoma in an Elderly Patient: A Case Report and Review of the Literature

Table 1

The literature review of case reports of elderly patients (>65) with primary EBV infectious mononucleosis.

Age	Gender	Presenting symptoms and signs	AST/ALT; (units/L)	Tbili; (mg/dL)	ALKP/GGT; (units/L)	Atypical lymphocytes	Serology/PCR	Radiographic studies	Liver biopsy; results	Treatment and outcome
68	M	Malaise and jaundice.	1553/1396	Tbili; 34; Dbili; 25	147/50	Present	Pos anti-VCA; IgM and negative anti-EBNA.	Normal imaging.	No biopsy performed.	Supportive management.; Improved during hospitalization [13].
66	F	Malaise, anorexia, and jaundice.	3090/1490	Tbili; 26.4; Dbili; 15.1	318/no GGT	Present	Pos monospot test, anti-VCA; IgM/IgG, and EBV PCR.	Abd US chronic liver disease changes.	Hepatitis and cirrhosis.	Prednisolone for AIH.; Asymptomatic at 2-month followup [14].
70	F	Fever, pharyngitis, and back pain.	339/390	Dbili; 0.4	524/no; GGT	Present	Pos heterophile antibody and anti-VCA IgM/IgG.	No radiographic studies.	No Biopsy performed.	Supportive treatment [1].
72	F	Sore throat, fever jaundice, splenomegaly, and fever.	904/1258	Tbili; 21.4; DBili; 15.9	370/250	Absent	Pos anti-VCA IgM, EBV PCR, anti-EBEA IgM. Neg anti-VCA IgG.	Normal imaging.	No Biopsy performed.	Supportive management.; Fatigue at 6-month followup [4].
67	F	Sore throat, fever, jaundice, and RUQ pain.	847/499	Tbili; 11.4; Dbili; 8.6	1389/198	Present	Pos monospot test and anti-VCA IgM/IgG.	Normal imaging.	Lymphocytic infiltration in; portal tracts.	Supportive management.; Asymptomatic at 3-month followup [4].
83	M	Night sweat and weight loss.	337/407	Tbili; 10.5	512/no GGT	Present	Pos heterophile antibody, anti-VCA IgM/IgG, and EBV PCR.	CT revealed splenomegaly and lymphadenopathy.	No biopsy performed.	Supportive management.; Asymptomatic at 1 month [15].
72	M	Loss of appetite and jaundice.	ALT-254	Tbili; 2.9	677/817	Present	Pos anti-VCA IgM/IgG and anti-EBNA IgG.	CT revealed splenomegaly.	No biopsy performed.	Supportive management. Asymptomatic at 4 months [16].
76	F	Falls and dizziness.	Not reported	Tbili; 5.7; Dbili; 1.5	Not reported	Absent	Pos anti-VCA IgM/IgG. Neg anti-EBEA and anti-EBNA.	CT revealed aortic lymphadenopathy.	No biopsy performed.	Supportive management. Asymptomatic at 6 months [17].
73	F	Falls and dizziness.	Not reported	Tbili; 1.2; Dbili; 0.3	Not reported	Absent	Pos anti-VCA IgM/IgG. Neg anti-EBEA and anti-EBNA.	Normal imaging.	No biopsy performed.	Supportive management. Asymptomatic at 6 months [17].

Abd US: abdominal ultrasound; AIH: autoimmune hepatitis; ALKP: alkaline phosphatase; ALT: alanine aminotransferase; anti-EBEA: anti-EBV early antigen antibody; anti-EBNA: anti-EBV-associated nuclear antigen antibody; anti-VCA: EBV anti-viral caspid antigen antibody; AST: aspartate aminotransferase; Dbili: direct bilirubin; GGT: gamma glutamyl transpeptidase; HIV: human immunodeficiency virus; IgG: immunoglobulin G; IgM: immunoglobulin M; Neg: negative; PCR: polymerase chain reaction; Pos: positive; Tbili: total bilirubin.
References: Dogan et al., 2007 [13], Koay et al., 2008 [14], Axelrod and Finestone, 1990 [1], Tahan et al., 2001 [4], Malfuson et al., 2011 [15], Thoufeeg et al., 2007 [16], and Dourakis et al., 2006 [17].