Dr. Kasey Holland Hamski, ND
A case illustrating the interaction between EBV reactivation, environmental mildew publicity, and immune dysregulation in a affected person with persistent post-viral fatigue.
This case report examines power fatigue in a 38-year-old affected person with post-COVID Epstein–Barr virus reactivation and unrecognized mildew publicity. By complete diagnostics and a phased, individualized therapy plan addressing fungal colonization, oxidative stress, and immune dysregulation, the affected person skilled sustained multisystem restoration and improved high quality of life.
Summary
Epstein-Barr virus (EBV) is thought for being the primary human oncogenic virus found. Present analysis has continued to develop as new correlations with power fatigue, CFS/ME, autoimmune situations and lengthy COVID-19 have been explored.1 It’s estimated that higher than 95% of individuals have been contaminated with EBV. Given its lineage within the Herpes household of viruses (Human herpes virus 4), the DNA plasmid of EBV alternates from a lytic to latent state, and as soon as a number is contaminated, the virus is ready to set up lifelong latency.2,3,5,6 Whereas the first presentation of Epstein-Barr virus – generally often known as infectious mononucleosis – is usually self-limited, EBV reactivation is more and more acknowledged in affiliation with power fatigue, ME/CFS, autoimmune situations, and multisystem syndromes.4 Regardless of rising medical recognition, precise symptom image, and causation for reactivation, diagnostics, and therapeutic pointers stay restricted. This case highlights the significance of figuring out underlying causes of Epstein-Barr virus reactivation and customizing therapy plans accordingly for decision of signs and prevention of additional pathology
Introduction
Epstein-Barr virus (EBV) was initially recognized for being the primary human oncogenic virus found. Present analysis has continued to develop as new correlations with power fatigue, CFS/ME, autoimmune situations, and lengthy COVID-19 have been introduced. Given its lineage within the Herpes household of viruses (Human herpes virus 4), the DNA plasmid of EBV alternates from a lytic to latent state and as soon as a number is contaminated, the virus is ready to set up lifelong latency. Whereas the first presentation of Epstein-Barr virus – generally often known as infectious mononucleosis – is often self- restricted, EBV reactivation is more and more acknowledged in affiliation with power fatigue, ME/CFS, autoimmune situations, and multisystem syndromes.2-6
Clinically when a affected person presents with fatigue of unrelenting nature it is very important embody Epstein-Barr virus reactivation within the differential analysis. In circumstances the place lab serology leaves room for grey space interpretation, it’s applicable to incorporate the affected person symptom image and historical past whereas making a medical analysis.
Moreover, for enhancing affected person outcomes, broader diagnostics investigating the reason for EBV reactivation and inclusion of therapies that handle it are important in therapy and backbone of signs. This case highlights the significance of diagnosing and treating mildew sickness along side EBV reactivation.
Case Presentation
Affected person: 38-year-old feminine
Previous Medical Historical past: The affected person introduced with issues of long-term fatigue with worsening signs after COVID-19, together with recurrent COVID-19 infections throughout the final two years. She examined optimistic for Epstein-Barr viral titers but had no symptom enchancment on her present therapy plan that included Myer’s Cocktail IVs, vitamin D, monolaurin, and L-lysine. The affected person introduced for analysis and different remedies for Epstein-Barr virus in addition to to find out if elevated EBV titers had been the supply of her fatigue. She was additionally being handled for autoimmune thyroiditis on the time.
Full Epstein – Barr Panel Analysis
| Lab | Diagnostic Methodology | Outcome |
| EBV VCA IgM | Serology | 13.3 Regular (Regular vary 0.0 – 43.9 U/mL) |
| EBV VCA IgG | Serology | 406.0 Excessive (Regular vary 0.0 – 21.9 U/mL) |
| EBV Nuclear Antigen IgG | Serology | 600.0 Excessive (Regular vary 0.0 – 21.9 U/mL) |
| EBV Early Antigen IgG | Serology | <5.0 Regular (Regular vary 0.0 – 10.9 U/mL) |
Preliminary Go to:
On the preliminary go to the affected person defined how she had long-standing fatigue that had been decided to be from hypothyroidism, however since contracting COVID-19, the fatigue had elevated, regardless of making an attempt many supportive therapies with out enchancment. She additionally reported sinus congestion, a good/ full feeling in her throat, occasional constipation, urinary frequency (particularly by way of the evening), ovarian ache day by day, hair loss after COVID-19, and vital mind fog and nervousness that typically resulted in panic assaults (particularly after her most up-to-date an infection with COVID-19). When requested about doable environmental exposures together with mildew publicity, she reported no exposures to her data, however did notice that she did odor a musty odor in her basement.
4 Weeks Later:
Whereas ready for lab outcomes monolaurin, L-lysine and Myer’s Cocktail IVs had been paused. Valacyclovir 1,000mg BID was initiated as an empirical trial to see if the affected person would enhance her signs, however this remedy was discontinued because the affected person had a rise in fatigue, nausea, and vertigo when taking Valacyclovir. This additional pointed to different elements contributing to her symptom image. The affected person’s mycotoxin urine take a look at and Natural acids urine checks got here again with the next outcomes that had been optimistic for mycotoxins and fungal colonization.
Mycotoxins Urine Check
| Lab | Diagnostic Methodology | Outcome |
| Mycotoxins | Urine |
|
Natural Acids Urine Check
| Marker | Diagnostic Methodology | Outcome |
| Arabinose | Urine | Elevated |
| 4 – Hydroxyhippuric | Urine | Elevated |
| HPHPA | Urine | Elevated |
| 3 – Hydroxybutyric | Urine | Elevated |
8 Weeks Later:
- Fatigue improved
- Charges power 8-9/10 with 10 being greatest
- Temper improved – much less nervousness, much less depressed
- Lower in mind fog
- Began exercising once more
Continued Care:
The affected person had follow-up visits over the course of the following 10 months with a couple of flare ups of signs that included hives after she was in a constructing that had mildew. Supportive histamine stabilizing therapies together with bromelain, vitamin C, and quercetin had been used to ease her signs as wanted. With every go to she continued to enhance and required much less interventions. She even began really fizzling out her thyroid remedy as she had extra power and wanted much less. Her bodily well being improved and her energy on the fitness center got here again. She additionally had emotional enhancements and was higher capable of make selections and deal with stress. She reported feeling higher than she had since so long as she may keep in mind. Immediately she practices wellness and optimizes her well being for longevity.
Intervention:
Part 1: Supportive Therapies for Symptom Administration, Antioxidant Assist, and Mobile Safety – Preparation for Systemic Antifungals
- Cease publicity to mildew in dwelling
- Diet: advisable anti-candida eating regimen
- Homeopathic drainage treatments
- Selenium
- Inositol 250 Grams
- Liposomal antioxidant components (curcumin 500 mg, trans-resveratrol 400 mg, omega-3s 1800 mg, alpha-GPC 300 mg, uridine 200 mg, and vitamin C 200 mg)
- Vitamin B-complex
- Rescue Treatment (Bach Flower Treatment) as wanted for nervousness
- Bitters 3x per day earlier than meals
- Leaky Intestine System (L-glutamine 3,000 mg, and a proprietary mix – 2,750 mg – of larch arabinogalactan bark powder (Larix laricina), marshmallow root powder (Althaea officinalis), deglycyrrhizinated licorice root (Glycyrrhiza glabra) powder [DGL], slippery elm bark powder (Ulmus rubra), and aloe vera internal leaf powder (Aloe barbadensis))
- Thymus vulgaris tincture 5- 10 drops in water TID
Part 2: Systemic Antifungals, Antioxidant Assist, and Multi-System Assist
- Diet: anti-candida eating regimen advisable
- Antifungal rotation of Fluconazole for 3 days, then thyme tincture for 4 days. Repeat for two weeks.
- Liposomal antioxidant components (curcumin 500 mg, trans-resveratrol 400 mg, omega-3s 1800 mg, alpha-GPC 300 mg, uridine 200mg, and vitamin C 200 mg)
- Selenium 200 mcg
- Vitamin B-complex
- Milk thistle (Silybum marianum) 1000 mg
- Propolis nasal spray BID
- Nasal rinse BID
- Thyme tincture 30 drops TID
- Broad spectrum probiotic
Part 3: Immune Supportive Therapies, Antioxidant Assist, Closing Antifungal Rotation
- Diet: anti-candida eating regimen advisable
- Antifungal rotation of Fluconazole for 3 days, then broad spectrum antifungal tincture for 4 days. Repeat for two weeks.
- Selenium 200 mcg
- Myo-inostitol 4 g
- Vitamin B-complex
- Broad-spectrum spore-based probiotic
- Modified Citrus Pectin 2.4 – 4.8 g
IV Remedy:
- 1 IV per week for 4 weeks:
- 10 g of vitamin C + vitamin B-complex
- Adopted by Glutathione push (I like to recommend having them begin low with 400 mg and rising to full dose)
Part 4: Upkeep
- Selenium 200 mcg
- Myo-inositol 4 g
- Vitamin B-complex
- Adrenal help components
- Probiotics
Outcomes:
Over the course of therapy spanning over 10 months, the affected person skilled constant enchancment, not simply in fatigue, however with different multisystem signs. By the top of her therapy, she reported that her power had once more greater than doubled. Her psychological well being and temper drastically improved. Signs of mind fog, urinary frequency, and ovarian ache additionally subsided. At her most up-to-date follow-up, she stays energetic and powerful, has decreased her thyroid drugs and solely follows-up for upkeep care.
Dialogue:
This case is an instance of complicated power sickness and how one can strategy care from a diagnostic and therapy perspective. Complicated power sickness requires wanting on the affected person’s symptom image underneath a large lens and contemplating how historical past, completely different pathologies, toxins, and the affected person’s present stress stage all work together.
Analysis introduced to NDNR on lengthy COVID-19 by Dr. Paul Anderson highlights the interaction between mildew, Epstein-Barr virus, and lengthy COVID-19. This mixture amplifies oxidative stress ranges and immune system vulnerabilities. Remedy should embody wide-reaching therapies that handle multisystem results and are extremely individualized for affected person’s particular person symptom photos.
Limitations:
On the time that this affected person introduced, there was restricted information and diagnostics on the impacts of the spike protein from COVID-19. Latest analysis now exhibits compounding results of this presentation, and I’d have added ‘SARS-CoV-2 Semi-Quantitative Whole Antibody, Spike’ to her lab work up and handled accordingly in step with therapy pointers advisable by Dr. Paul Anderson in his assessment.1
Conclusion:
This case highlights the significance of figuring out sources of oxidative stress and immune dysregulation that may shift the affected person’s setting and trigger reactivation of Epstein-Barr virus. Addressing underlying root causes whereas concurrently treating Epstein-Barr virus is vital for complete therapy and backbone of signs.
Dr. Kasey Holland, ND, is a nationally acknowledged naturopathic physician and thought chief within the area of power infections, specializing in Epstein-Barr Virus (EBV), Lyme illness, and mildew sickness. Drawing from her personal therapeutic journey and years of medical expertise, she has turn out to be a trusted voice for sufferers searching for solutions to “thriller sicknesses” too typically dismissed in typical drugs. Dr. Holland is the creator of EBV Bootcamp, an modern program that empowers people with a step-by-step roadmap to restoration, and she or he is a sought-after speaker who has educated each sufferers and professionals by way of platforms such because the Wisconsin Naturopathic Docs Affiliation, Pharm-to-Desk Persevering with Training, and the Worldwide Congress of Micro-Immunotherapy (ICoMI). Recognized for her potential to translate complicated science into sensible, actionable methods, Dr. Holland bridges naturopathic knowledge with evidence-based drugs, serving to to reshape how power viral reactivation and environmental drugs are approached in modern-day drugs.
References:
- Anderson PS. Publish-Pandemic Medical Drugs: Addressing Lengthy-COVID and Vaccine Accidents. Naturopathic Physician Information and Evaluate. 2025. Accessed January 2026. https://ndnr.com/2025-september-infectious-diseases-post-viral/long-covid-vaccine-injuries-treatment/
- Chakravarthi N, et al. Epstein–Barr virus in autoimmune illness and malignancy. Frontiers in Immunology. 2022;13:873680. https://pubmed.ncbi.nlm.nih.gov/35482424/
- Hille C, Döring C, Diehl V, Tesch H. Epstein–Barr virus: Reactivation and pathogenesis. Journal of Medical Virology. 2004;31(1):1-6. https://pubmed.ncbi.nlm.nih.gov/15386591/
- Loebel M, et al. Cytomegalovirus, Epstein-Barr virus, and human herpesvirus-6 infections in sufferers with myalgic encephalomyelitis/power fatigue syndrome (ME/CFS). Journal of Medical Virology. 2020;92(2):310-318.
- Pender MP, Burrows SR. EBV and the pathogenesis of autoimmune illness. Present Molecular Drugs. 2018;18(7):526-537. https://pubmed.ncbi.nlm.nih.gov/29525635/
- Tsuruga Okay, Kawano Y. Epstein–Barr virus and immune dysregulation. Frontiers in Immunology. 2020;11:587380. https://www.frontiersin.org/articles/10.3389/fimmu.2020.587380/full