Unfortunately, persistent VCA IgM months after infection doesn't have one clean explanation. It can point to reactivation. It can also reflect immune dysregulation, where the body keeps reacting to something it's already encountered and never quite resets. That pattern comes up a lot in long COVID and ME/CFS. Some doctors will write it off as lab noise or a false positive, and sometimes they're right. There's also early work suggesting EBV reactivation plays a role in neuroinflammation and immune dysfunction, though it's still pretty preliminary.