Dr. Kasey Holland Hamski, ND

A case illustrating the interplay between EBV reactivation, environmental mold exposure, and immune dysregulation in a patient with persistent post-viral fatigue.

This case report examines chronic fatigue in a 38-year-old patient with post-COVID Epstein–Barr virus reactivation and unrecognized mold exposure. Through comprehensive diagnostics and a phased, individualized treatment plan addressing fungal colonization, oxidative stress, and immune dysregulation, the patient experienced sustained multisystem recovery and improved quality of life.

Abstract

Epstein-Barr virus (EBV) is known for being the first human oncogenic virus discovered. Current research has continued to expand as new correlations with chronic fatigue, CFS/ME, autoimmune conditions and long COVID-19 have been explored.1 It is estimated that greater than 95% of people have been infected with EBV. Given its lineage in the Herpes family of viruses (Human herpes virus 4), the DNA plasmid of EBV alternates from a lytic to latent state, and once a host is infected, the virus is able to establish lifelong latency.2,3,5,6 While the primary presentation of Epstein-Barr virus – commonly known as infectious mononucleosis – is  typically self-limited, EBV reactivation is increasingly recognized in association with chronic fatigue, ME/CFS, autoimmune conditions, and multisystem syndromes.4 Despite growing clinical recognition, actual symptom picture, and causation for reactivation, diagnostics, and therapeutic guidelines remain limited. This case highlights the importance of identifying underlying causes of Epstein-Barr virus reactivation and customizing treatment plans accordingly for resolution of symptoms and prevention of further pathology

Introduction

Epstein-Barr virus (EBV) was originally known for being the first human oncogenic virus discovered. Current research has continued to expand as new correlations with chronic fatigue, CFS/ME, autoimmune conditions, and long COVID-19 have been presented. Given its lineage in the Herpes family of viruses (Human herpes virus 4), the DNA plasmid of EBV alternates from a lytic to latent state and once a host is infected, the virus is able to establish lifelong latency. While the primary presentation of Epstein-Barr virus – commonly known as infectious mononucleosis – is typically self- limited, EBV reactivation is increasingly recognized in association with chronic fatigue, ME/CFS, autoimmune conditions, and multisystem syndromes.2-6

Clinically when a patient presents with fatigue of unrelenting nature it is important to include Epstein-Barr virus reactivation in the differential diagnosis. In cases where lab serology leaves room for gray area interpretation, it is appropriate to include the patient symptom picture and history while making a clinical diagnosis. 

Furthermore, for improving patient outcomes, broader diagnostics investigating the cause of EBV reactivation and inclusion of therapies that address it are essential in treatment and resolution of symptoms. This case highlights the importance of diagnosing and treating mold illness in conjunction with EBV reactivation.

Case Presentation

Patient: 38-year-old female 

Past Medical History: The patient presented with concerns of long-term fatigue with worsening symptoms after COVID-19, along with recurrent COVID-19 infections within the last two years. She tested positive for Epstein-Barr viral titers yet had no symptom improvement on her current treatment plan that included Myer’s Cocktail IVs, vitamin D, monolaurin, and L-lysine. The patient presented for evaluation and alternative treatments for Epstein-Barr virus as well as to determine if elevated EBV titers were the source of her fatigue. She was also being treated for autoimmune thyroiditis at the time.

Complete Epstein – Barr Panel Evaluation

Lab	Diagnostic Method	Result
EBV VCA IgM	Serology	13.3 Normal (Normal range 0.0 – 43.9 U/mL)
EBV VCA IgG	Serology	406.0 High (Normal range 0.0 – 21.9 U/mL)
EBV Nuclear Antigen IgG	Serology	600.0 High (Normal range 0.0 – 21.9 U/mL)
EBV Early Antigen IgG	Serology	<5.0 Normal (Normal range 0.0 – 10.9 U/mL)

Initial Visit: 

At the initial visit the patient explained how she had long-standing fatigue that had been determined to be from hypothyroidism, but since contracting COVID-19, the fatigue had increased, despite trying many supportive therapies without improvement. She also reported sinus congestion, a tight/ full feeling in her throat, occasional constipation, urinary frequency (especially through the night), ovarian pain daily, hair loss after COVID-19, and significant brain fog and anxiety that sometimes resulted in panic attacks (especially after her most recent infection with COVID-19). When asked about possible environmental exposures including mold exposure, she reported no exposures to her knowledge, but did note that she did smell a musty smell in her basement.

4 Weeks Later:

While waiting for lab results monolaurin, L-lysine and Myer’s Cocktail IVs were paused. Valacyclovir 1,000mg BID was initiated as an empirical trial to see if the patient would improve her symptoms, but this therapy was discontinued as the patient had an increase in fatigue, nausea, and vertigo when taking Valacyclovir. This further pointed to other factors contributing to her symptom picture. The patient’s mycotoxin urine test and Organic acids urine tests came back with the following results that were positive for mycotoxins and fungal colonization. 

Mycotoxins Urine Test

Lab	Diagnostic Method	Result
Mycotoxins	Urine	Aflatoxin M1 Ochratoxin A

 

Organic Acids Urine Test

Marker	Diagnostic Method	Result
Arabinose	Urine	Elevated
4 – Hydroxyhippuric	Urine	Elevated
HPHPA	Urine	Elevated
3 – Hydroxybutyric	Urine	Elevated

 

8 Weeks Later:

• Fatigue improved
• Rates energy 8-9/10 with 10 being best
• Mood improved – less anxiety, less depressed
• Decrease in brain fog
• Started exercising again

Continued Care:

The patient had follow-up visits over the course of the next 10 months with a few flare ups of symptoms that included hives after she was in a building that had mold. Supportive histamine stabilizing therapies including bromelain, vitamin C, and quercetin were used to ease her symptoms as needed. With each visit she continued to improve and required less interventions. She even started tapering off her thyroid medication as she had more energy and needed less. Her physical health improved and her strength at the gym came back. She also had emotional improvements and was better able to make decisions and handle stress. She reported feeling better than she had since as long as she could remember. Today she practices wellness and optimizes her health for longevity.

Intervention:

Phase 1: Supportive Therapies for Symptom Management, Antioxidant Support, and Cellular Protection – Preparation for Systemic Antifungals

• Stop exposure to mold in home
• Nutrition: recommended anti-candida diet
• Homeopathic drainage remedies
• Selenium 
• Inositol 250 Grams 
• Liposomal antioxidant formula (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 Remedy (Bach Flower Remedy) as needed for anxiety
• Bitters 3x per day before meals
•  Leaky Gut Formula (L-glutamine 3,000 mg, and a proprietary blend – 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 inner leaf powder (Aloe barbadensis))
•  Thymus vulgaris tincture 5- 10 drops in water TID

Phase 2: Systemic Antifungals, Antioxidant Support, and Multi-System Support

• Nutrition: anti-candida diet recommended
• Antifungal rotation of Fluconazole for 3 days, then thyme tincture for 4 days. Repeat for 2 weeks.
• Liposomal antioxidant formula (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

Phase 3: Immune Supportive Therapies, Antioxidant Support, Final Antifungal Rotation

• Nutrition: anti-candida diet recommended
• Antifungal rotation of Fluconazole for 3 days, then broad spectrum antifungal tincture for 4 days. Repeat for 2 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 Therapy:

• 1 IV per week for 4 weeks:
  • 10 g of vitamin C + vitamin B-complex
  • Followed by Glutathione push (I recommend having them start low with 400 mg and increasing to full dose)

Phase 4: Maintenance

• Selenium 200 mcg
• Myo-inositol 4 g 
• Vitamin B-complex
• Adrenal support formula
• Probiotics

Outcomes:

Over the course of treatment spanning over 10 months, the patient experienced consistent improvement, not just in fatigue, but with other multisystem symptoms. By the end of her treatment, she reported that her energy had again more than doubled. Her mental health and mood greatly improved. Symptoms of brain fog, urinary frequency, and ovarian pain also subsided. At her most recent follow-up, she remains energetic and strong, has decreased her thyroid medications and only follows-up for maintenance care. 

Discussion:

This case is an example of complex chronic illness and how to approach care from a diagnostic and treatment perspective. Complex chronic illness requires looking at the patient’s symptom picture under a wide lens and considering how history, different pathologies, toxins, and the patient’s current stress level all interact. 

Research presented to NDNR on long COVID-19 by Dr. Paul Anderson highlights the interplay between mold, Epstein-Barr virus, and long COVID-19. This combination amplifies oxidative stress levels and immune system vulnerabilities. Treatment must include wide-reaching therapies that address multisystem effects and are highly individualized for patient’s individual  symptom pictures.

Limitations:

At the time that this patient presented, there was limited data and diagnostics on the impacts of the spike protein from COVID-19. Recent research now shows compounding effects of this presentation, and I would have added ‘SARS-CoV-2 Semi-Quantitative Total Antibody, Spike’ to her lab work up and treated accordingly in line with treatment guidelines recommended by Dr. Paul Anderson in his review.1

Conclusion:

This case highlights the importance of identifying sources of oxidative stress and immune dysregulation that can shift the patient’s environment and cause reactivation of Epstein-Barr virus. Addressing underlying root causes while concurrently treating Epstein-Barr virus is important for comprehensive treatment and resolution of symptoms.

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Dr. Kasey Holland, ND, is a nationally recognized naturopathic doctor and thought leader in the field of chronic infections, specializing in Epstein-Barr Virus (EBV), Lyme disease, and mold illness. Drawing from her own healing journey and years of clinical experience, she has become a trusted voice for patients seeking answers to “mystery illnesses” too often dismissed in conventional medicine. Dr. Holland is the creator of EBV Bootcamp, an innovative program that empowers individuals with a step-by-step roadmap to recovery, and she is a sought-after speaker who has educated both patients and professionals through platforms such as the Wisconsin Naturopathic Doctors Association, Pharm-to-Table Continuing Education, and the International Congress of Micro-Immunotherapy (ICoMI). Known for her ability to translate complex science into practical, actionable strategies, Dr. Holland bridges naturopathic wisdom with evidence-based medicine, helping to reshape how chronic viral reactivation and environmental medicine are approached in modern day medicine.

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References: 

1. Anderson PS. Post-Pandemic Clinical Medicine: Addressing Long-COVID and Vaccine Injuries. Naturopathic Doctor News and Review. 2025. Accessed January 2026. https://ndnr.com/2025-september-infectious-diseases-post-viral/long-covid-vaccine-injuries-treatment/
2. Chakravarthi N, et al. Epstein–Barr virus in autoimmune disease and malignancy. Frontiers in Immunology. 2022;13:873680. https://pubmed.ncbi.nlm.nih.gov/35482424/
3. Hille C, Döring C, Diehl V, Tesch H. Epstein–Barr virus: Reactivation and pathogenesis. Journal of Clinical Virology. 2004;31(1):1-6. https://pubmed.ncbi.nlm.nih.gov/15386591/
4. Loebel M, et al. Cytomegalovirus, Epstein-Barr virus, and human herpesvirus-6 infections in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Journal of Medical Virology. 2020;92(2):310-318.
5. Pender MP, Burrows SR. EBV and the pathogenesis of autoimmune disease. Current Molecular Medicine. 2018;18(7):526-537. https://pubmed.ncbi.nlm.nih.gov/29525635/
6. Tsuruga K, 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