False-Positive Monospot in a Returning Traveler with Dengue Fever.

The heterophile antibody (Monospot), initial test of choice for Epstein-Barr virus (EBV)-associated infectious mononucleosis, is both sensitive (70-92%) and specific (96-100%). False positives have been demonstrated in cases of viral hepatitis, human immunodeficiency virus, leukemia, lymphoma, pancreatic cancer, systemic lupus erythematosus, and rubella. We present a case of a 46-yr-old male who developed fever, chills, headaches, myalgia, fatigue, and photophobia 1 d after returning from the Philippines. He demonstrated a mild transaminitis and significant thrombocytopenia (12,000 cells/µL). His initial evaluation revealed a positive heterophile antibody test. Without a classic EBV presentation, a fever in returning traveler evaluation was instituted resulting in a positive dengue test by direct fluorescence IgM (8.82 IU) and IgG (7.13 IU), respectively. Both his EBV DNA polymerase chain reaction and IgM by viral capsid antigen were negative. Dengue, an RNA flavivirus, and the dengue antibody have demonstrated cross-reactivity with other flaviviruses including Japanese encephalitis virus, yellow fever virus, West Nile virus, and St. Louis encephalitis. However, EBV is a double-helix DNA herpesvirus and structurally very different. To our knowledge, this is the first reported case of cross-reactivity between dengue and EBV that describes a potential false positive for the heterophile antibody test.

Sickle Cell Trait Complicated by Acute Rhabdomyolysis in Military Personnel: A Case Report.

Sickle cell trait, a trait known to be protective against falciparum malaria, is prevalent in the African American community. Unlike true sickle cell disease, sickle cell trait is currently not a disqualifying condition for military service. In the case below, we describe an occurrence, from Logar Provence, Afghanistan (2,072 m above mean sea level), of exertional acute rhabdomyolysis in an American service member known to be a sickle cell trait carrier. The case serves to educate Military Medical providers and Commanders alike, to the increased risk certain training and work environments have on sickle cell trait Service members; it raises the question of what duty limitations, if any, sickle cell carriers should have.

A case of tick-bite-induced red meat allergy.

Delayed hypersensitivity disorders and food allergies are often challenging for the clinician and patient alike. A recent discovery of an IgE antibody specific to galactose-α-1,3-galactose, which is a carbohydrate abundantly expressed on cells and tissues of beef, pork, and lamb, adds one more tool to aid the clinician in making the appropriate diagnosis. A link has been discovered between the bite of the Lone Star Tick (Amblyomma americanum) and the development of sensitivity to galactose-α-1,3-galactose. With a high prevalence of Lone Star Tick populations inhabiting major U.S. Army Installations, and the type of duty required by our Service members, it could potentially affect susceptible individuals. We describe a case of an active duty soldier who went 4 years searching for this elusive diagnosis and connection and discuss why it should remain in the differential diagnosis when treating military health care beneficiaries.