Familial Chronic Mononucleosis

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Abstract
A syndrome of chronic mononucleosis occurred in 2 members of a family. Symptoms were chronic malaise and fatigue; recurrent upper respiratory tract infections; and mild, variable immune abnormalities. Intermittently positive heterophil titers were present for > 2 yr after acute infectious mononucleosis. Epstein-Barr virus-specific antibodies were persistently abnormal. In the proband, the R component of the early antigen complex was present for 3 yr and the patient never developed normal antibodies to Epstein-Barr nuclear antigen. Her brother had low to absent Epstein-Barr nuclear antigen titers, and antibodies to both the R and D component of the early antigen complex. Primary and acquired immunodeficiency states can show abnormal Epstein-Barr virus-specific serologic findings that may reflect an attempt by the host to limit virus spread in the presence of deficient immune responses. This action may result in alterations of the Epstein-Barr virus-latent state, and lead to a chronic active infection and a syndrome of chronic mononucleosis.