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False-positive treponemal syphilis serology linked to EBV-related heterophile antibodies: Insights from a
Mengjie Luo1, Yi Wu1, Qiling Lin1
1Shenzhen Yantian District People's Hospital, Shenzhen, Guangdong 518081, China.
Background:
Syphilis serological false positives associated with interference from heterophile antibodies induced by Epstein-Barr virus (EBV) remain rarely reported. This report aims to document a rare case of syphilis serology discordance ultimately attributed to EBV infection, imitating syphilis serology.
Case Presentation:
A 34-year-old woman presented with facial skin lesions and underwent syphilis screening. Initial testing revealed reactive Treponema pallidum (T. pallidum) antibody (TP-Ab), positive T. pallidum particle agglutination assay (TPPA), and negative toluidine red unheated serum test (TRUST). Subsequent testing, including chemiluminescent platforms, immunofluorescence (FTA-ABS), Western blot, and colloidal gold methods, was non-reactive. Comprehensive workup for autoimmune and endocrine disorders was unremarkable. Further investigation revealed elevated antiphospholipid antibodies and positive EBV serologies. EBV DNA was detected. After heterophilic antibody blocking, TPPA and TP-Ab returned to negative, confirming false-positive results.
Conclusion:
This case illustrates that heterophile antibody interference can simultaneously affect both particle agglutination and chemiluminescence-based treponemal assays, leading to false-positive results. It emphasizes the necessity of interpreting serological findings in conjunction with clinical history and, when appropriate, confirmatory molecular testing, in order to prevent misdiagnosis and unnecessary treatment.
