Case history
Case history
A 16-year-old student presents with fever, sore throat, and fatigue. She started feeling ill 1 week ago. Her symptoms are gradually getting worse, and she has difficulty swallowing. She has had a fever every day, and she could hardly get out of bed this morning. She does not remember being exposed to anybody with a similar illness recently. On physical examination she is febrile and looks ill. Enlarged cervical lymph nodes, exudative pharyngitis with soft palate petechiae and faint erythematous macular rash on the trunk and arms are found.
Other presentations
Diagnosis of IM is not uncommon in febrile travellers, and a higher proportion of Epstein-Barr virus (EBV) negative mononucleosis syndrome has been observed in this group.[4] Splenic rupture has been reported in patients with IM at the initial presentation or before the development of the typical symptoms.[5] Older adults may present with hepatitis or fever of unknown origin.[6][7] Patients may present with a neurological disorder without typical concomitant IM signs, and in some cases a neurological disorder (e.g., facial nerve palsy, Guillain-Barre syndrome, encephalitis) could be the sole manifestation of EBV infection in children.[8][9] Other rare manifestations in children include acute dacryocystitis, upper airway obstruction, pneumonia, acute myocarditis, aplastic anaemia, agranulocytosis, renal dysfunction, genital ulceration, hepatitis, cholecystitis, acute liver failure, psychotic episodes, depression, allergies, Hodgkin's lymphoma, Burkitt's lymphoma, and other neoplasms.[10]
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