Table 1: The literature review of case reports of elderly patients (>65) with primary EBV infectious mononucleosis.

AgeGenderPresenting symptoms and signsAST/ALT
(units/L)
Tbili
(mg/dL)
ALKP/GGT
(units/L)
Atypical lymphocytesSerology/PCRRadiographic studiesLiver biopsy
results
Treatment and outcome

68MMalaise and jaundice.1553/1396Tbili
34
Dbili
25
147/50PresentPos anti-VCA
IgM and negative anti-EBNA.
Normal imaging.No biopsy performed.Supportive management.
Improved during hospitalization [13].

66FMalaise, anorexia, and jaundice.3090/1490Tbili
26.4
Dbili
15.1
318/no GGTPresentPos 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].

70FFever, pharyngitis, and back pain.339/390Dbili
0.4
524/no
GGT
PresentPos heterophile antibody and anti-VCA IgM/IgG. No radiographic studies.No Biopsy performed.Supportive treatment [1].

72FSore throat, fever jaundice, splenomegaly, and fever.904/1258Tbili
21.4
DBili
15.9
370/250AbsentPos 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].

67FSore throat, fever, jaundice, and RUQ pain.847/499Tbili
11.4
Dbili
8.6
1389/198PresentPos monospot test and anti-VCA IgM/IgG. Normal imaging.Lymphocytic infiltration in
portal tracts.
Supportive management.
Asymptomatic at 3-month followup [4].

83MNight sweat and weight loss.337/407Tbili
10.5
512/no GGTPresentPos heterophile antibody, anti-VCA IgM/IgG, and EBV PCR. CT revealed splenomegaly and lymphadenopathy.No biopsy performed.Supportive management.
Asymptomatic at 1 month [15].

72MLoss of appetite and jaundice.ALT-254Tbili
2.9
677/817PresentPos anti-VCA IgM/IgG and anti-EBNA IgG.CT revealed splenomegaly.No biopsy performed. Supportive management. Asymptomatic at 4 months [16].

76 FFalls and dizziness.Not reportedTbili
5.7
Dbili
1.5
Not reportedAbsentPos anti-VCA IgM/IgG. Neg anti-EBEA and anti-EBNA.CT revealed aortic lymphadenopathy.No biopsy performed.Supportive management. Asymptomatic at 6 months [17].

73FFalls and dizziness.Not reportedTbili
1.2
Dbili
0.3
Not reportedAbsentPos 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].