I was diagnosed with CMV last year and was out of work for about six months. I also contracted mono, with an enlarged spleen and liver. Ever since, I have had abdominal pain on the right side just under the rib cage. I've been tested for gallbladder problems and got the all-clear with the CMV. But the pain has worsened and seems to me to be lasting too long to be nothing. Could it be a weakened area from the illness? Do you have any other suggestions?

K.D.

There are several important points to be made regarding your question. First, let's talk about the different categories of infection with cytomegalovirus (CMV). In people with immune weakness -- including HIV patients as well as transplant recipients on antirejection drugs -- CMV can cause serious problems, such as retinitis (infection of the retina of the eye), pneumonia or encephalitis (brain infection). On the other hand, most healthy people who get infected with CMV never get any symptoms at all. Others get a syndrome consisting of fever, swollen lymph nodes, weakness and sometimes liver inflammation (hepatitis). The illness lasts less than a month, and then the patient is back to normal.
This last syndrome is very similar to infectious mononucleosis, or "mono." Mono is caused by a different microbe, the Epstein-Barr virus (EBV). Now, what about the pain on your right side? It certainly sounds like it's your liver, though I could not tell for sure without a physical examination and some blood tests. Chronic infection of the liver with one of the hepatitis viruses can sometimes cause long-lasting pain in the right upper part of the belly, but this is not expected with EBV or CMV infection. As you mention, problems with the gallbladder can also cause periodic pain in this area.

In your case, I wonder how certain were the diagnoses of CMV and EBV. I would be surprised if you came down with both infections, one right after the other. While it is possible that you were infected with both viruses, it is also possible that you have another process altogether -- such as hepatitis infection -- and never really had CMV or EBV.

Both CMV and EBV infections are typically diagnosed by lab tests that look for infection-fighting antibodies in the blood. The antibody tests for CMV often yield confusing results, and I have seen quite a number of falsely positive tests. EBV is a little easier to diagnose, if the right exam is used. The monospot test, which is used in most labs, is pretty good but not as accurate as other tests. But even the most accurate antibody screen for EBV (called the "antibody to the viral capsid antigen" test) can sometimes be unreliable. In other words, it is not always wise to be completely confident in the diagnoses of EBV or CMV.

What should you do? Start by asking your doctor how certain he or she is that you had EBV or CMV. Find out if your doctor has checked you for the hepatitis viruses. Finally, a blood test can be useful for examining the possibility of gallbladder disease, and a sonogram (ultrasound exam) can rule it out.