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August 21, 1987

'Chronic Active Epstein-Barr Virus Infection'

JAMA. 1987;258(7):907. doi:10.1001/jama.1987.03400070045014

To the Editor.—  I was surprised by the approach taken by Buchwald et al1 in their recent study of what they term chronic active Epstein-Barr virus (EBV) infection. The authors defined their study group solely on the basis of self-reporting of symptoms by patients. The symptom complex associated with "chronic active EBV infection" is compatible with many other organic disorders, as well as with psychoneurosis. A serious study of this syndrome would surely include only those patients who combine the appropriate symptomatology with physical findings such as lymphadenopathy, pharyngitis, hepatomegaly, splenomegaly, or fever, preferably chronic and unexplained by appropriate workup. The reported clinical findings (none of the patients had fever, pharyngitis, hepatomegaly, or splenomegaly and a minority had lymphadenopathy) support my feeling that few, if any, of the patients in the study suffered from the syndrome seen at Incline Village, Nev,2 and elsewhere.The reported prevalence of 21%