We discussed a case of a healthy young man who presented with fevers, malaise, n/v, found to have posterior cervical lymphadenopathy and acute hepatitis due to infectious mononucleosis.

Clinical manifestations

• Fevers, pharyngitis, tonsillar exudates, malaise, lymphadenopathy (posterior cervical / posterior auricular), atypical lymphocytosis
• Splenomegaly
• Hepatitis

Diagnosis

• Heterophile / Monospot test (low sensitivity and specificity). Can have false negative during early infection
• EBV specific antibodies to viral capsid Ag (earlier increase in serum levels) or nuclear Ag (later increase in serum levels)

Complications

• Acute complications
  • Rash (classically associated with administrations of ampicillin)
  • Peritonsillar abscess (watch out for airway obstruction!)
• Lymphoproliferative disorders (e.g. HLH, lymphomatoid granulomatosis)
• Malignancies (e.g. lymphomas, nasopharyngeal carcinoma)