Expert: Neha Dahiya MD - 6/9/2009

Question
My daughter is 17 years old.  This past January, she became ill and stayed really sick for 3+ weeks.  She was sleeping 16-18 hours a day, had a sore throat, achy, swollen joints, enlarged lymph nodes and her splenic measurement was a "12" 4 weeks into her illness.
During that time, she was diagnosed with a urinary tract infection, which took two antibiotics to clear.
She was tested for strep, mono-spot test, mono blood test, and a flu swab, all of which were negative.  These tests were all done in the middle of her illness, when she was at her worst.  
As some background, she was recently diagnosed with ADD and is taking Adderall.  She also suffered a pretty bad concussion in December, CT scan showed no bleed.

After this long, she is STILL having days, even on the Adderall, that she can barely get out of bed.  Her glands get swollen, her joints ache and she is so fatigued, she can barely get to the bathroom.  I took her to an adolescent medical specialist who ran an EBV titer test and attributes her illness to mono, even though she had two negative tests. If my memory serves me correctly, she had mono several years ago, but I can't be 100% positive (getting her medical records from her old doctor has proved to be a nightmare!).
I just wonder if I need to follow up with an infectious disease doctor or keep playing the waiting game.  She is really tired of being sick and tired all the time.  My once active, normal athletic daughter can barely run around the softball field any longer.  
Here are the results of her EBV titer test:
VCA Antibody (IGM) 0.62
VCA Antibody (IGG) 2.92
EBNA Antibody (IGG) 4.44

Any help you can offer is greatly appreciated!!

Answer
Hello Lisa:

Each lab has a cutoff / reference range for the antibody levels. This helps to determine if the value is significant enough to be considered positive. The reference range would have helped in better interpretation.

Going by the VCA IGM level it appears very low and maybe considered negative. In which case the other two if taken as positive. would indicate a recent infection.

The symptoms and age  do fit into infectious mononucleosis. This is however a self limiting disease and take  couple of weeks for recovery.
The only precaution needed with the enlarged spleen is to avoid moderate to high intensity activity, not to lift heavy objects etc so as to prevent spleen rupture.

One of the side effects of Adderall is urinary tract infection.
You may consult an ID specialist to relieve your anxiety