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Thursday, May 23, 2013
MG and mono
If a person with MG is exposed to someone that had Mononucleosis over a month ago, what are the risks, concerns, etc., if any?
Mononucleosis is a viral infection caused by EBV (Epstein-Barr Virus), a virus that a large percent of our population has been exposed to (up to 90% of people by adulthood). Most cases are subclinical. The odds are that you had already been exposed. Symptoms include fatigue, swollen lymph nodes, and sore throat after a 1-2 month incubation. Healthy older adults actually are more likely to have a presentation like viral hepatitis. The spleen can also be involved, an organ under the left lower rib cage that is involved with the lymph nodes.
Immunosuppression, aka prednisone and azathioprine, may increase your risk of infection or unmask old infection. The T cell response, which is reduced with immunosuppression, is important to contain the EBV infection. A special concern is the possibility of lymphoproliferative disease associated with immunosuppression, akin to lymphoma (called post-transplant lymphoproliferative disorder). This is a rare, rare complication, and usually is seen with higher levels of immunosuppression than most myasthenics require (aka transplant patients).
All that being said, most people never even know they have been exposed and have no problems. What I mentioned above are worst case scenarios. Probably more important for a myasthenic is to have a flare of your myasthenic symptoms for a short period. Just be vigilant about your symptoms and be especially mindful of shortness of breath, swallowing/chewing difficulties, and slurred speech. Keep your treating doctor in the know if these symptoms start to appear or worsen for you.
Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati