EBV and CMV mononucleosis vs Acute HIV infection
How to tell EBV and CMV mononucleosis and Acute HIV infection apart when a board question makes them look alike.
EBV = heterophile-positive pharyngitis/posterior nodes/splenomegaly; CMV = heterophile-negative mono; acute HIV = high RNA/p24 with rash/ulcers and early antibody gap.
Side by side
EBV mono causes fever, pharyngitis, posterior cervical lymphadenopathy, splenomegaly, atypical lymphocytes, and positive heterophile test; CMV mono is heterophile-negative with less prominent pharyngitis.
Acute HIV causes mononucleosis-like fever, sore throat, diffuse rash, mucocutaneous ulcers, lymphadenopathy, diarrhea, high HIV RNA/p24, and antibody negativity early.
EBV infects B cells and triggers reactive cytotoxic T cells; CMV causes heterophile-negative mono-like illness.
Acute HIV is early high-level viremia before full antibody seroconversion.
Positive heterophile or EBV VCA IgM supports EBV; CMV IgM/PCR with negative heterophile supports CMV mono.
High HIV RNA, positive p24 antigen, recent exposure, rash/ulcers, and negative or indeterminate antibody testing support acute HIV.
The trap
A mono-like illness after high-risk exposure needs acute HIV testing even if the initial antibody test is negative.
The repair move
For mono-like illness, check heterophile/EBV testing, CMV testing, and acute HIV RNA/p24 based on exposure.
Try a free question
CoreA college student has fever, severe pharyngitis, posterior cervical lymphadenopathy, splenomegaly, atypical lymphocytes, and positive heterophile test. Which diagnosis is most likely?
Show answer and explanation
Answer: A. EBV infectious mononucleosis. Fever, pharyngitis, posterior cervical nodes, splenomegaly, atypical lymphocytes, and positive heterophile test support EBV mono.
Why the other choices are tempting
- B. Acute HIV needs RNA/p24 clues, high-risk exposure, rash/ulcers, or antibody-window pattern.
- C. CMV mono is usually heterophile-negative.
- D. Secondary syphilis causes palms/soles rash and mucous lesions.
- E. TB causes chronic pulmonary/systemic granulomatous disease.
Flashcards
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What lymph node pattern supports EBV mono?
Posterior cervical lymphadenopathy supports EBV infectious mononucleosis.
What test supports EBV mono?
A positive heterophile test or EBV VCA IgM supports EBV mono.
Quick answers
What is the fastest way to tell EBV and CMV mononucleosis from Acute HIV infection?
EBV = heterophile-positive pharyngitis/posterior nodes/splenomegaly; CMV = heterophile-negative mono; acute HIV = high RNA/p24 with rash/ulcers and early antibody gap.
What is the key clue for EBV and CMV mononucleosis?
EBV mono causes fever, pharyngitis, posterior cervical lymphadenopathy, splenomegaly, atypical lymphocytes, and positive heterophile test; CMV mono is heterophile-negative with less prominent pharyngitis.
What is the key clue for Acute HIV infection?
Acute HIV causes mononucleosis-like fever, sore throat, diffuse rash, mucocutaneous ulcers, lymphadenopathy, diarrhea, high HIV RNA/p24, and antibody negativity early.
What is the common trap with EBV and CMV mononucleosis vs Acute HIV infection?
A mono-like illness after high-risk exposure needs acute HIV testing even if the initial antibody test is negative.