![]() 216 It is in the atypical case, presenting with lymphadenopathy without fever, sore throat, or splenomegaly, that the clinician will perform a lymph node biopsy to rule out the possibility of malignant lymphoma. 215 It is rare for the pathologist to see a lymph node from a patient with a typical clinical picture because in most instances the presumptive clinical diagnosis is confirmed by examination of the peripheral blood and serologic evaluation without need of a lymph node biopsy. The etiologic agent of classic infectious mononucleosis is EBV, 214 but other agents may be involved in atypical cases. Goldblum MD, in Rosai and Ackerman's Surgical Pathology, 2018 Infectious Mononucleosis īox 1 and Table 1 summarize the features of IM in immunocompetent patients.ĮBV may also cause hemophagocytic disease, alternatively referred to as EBV-associated hemophagocytic lymphohistiocytosis (EBV-HLH), characterized by fever, splenomegaly, and cytopenias with high ferritin and soluble CD25.Late complications may include lymphoproliferative cancers (Burkitt lymphoma and Hodgkin lymphoma), multiple sclerosis, rheumatoid arthritis, and chronic active EBV infection (CAEBV). Acute tonsillectomy may be pursued if steroids are not sufficient to mitigate the risk for obstruction. Systemic corticosteroids are indicated for treating those at risk or with impending airway obstruction, and usually leads to improvement in 12 to 36 hr. Īirway compromise, as evidenced by stridor, cyanosis, and/or tachypnea, is reported in 1% to 3% of cases and is an indication for hospitalization.Most cases occur in the first 3 wk of symptoms. It should be suspected in anyone with confirmed or suspected IM who presents with acute abdominal or chest pain. Splenic rupture is rare, with an incidence rate <1%, but it is the most feared. Reported complications include cholestatic liver disease, chronic hepatitis, or even liver failure hemolytic anemia splenic rupture or airway compromise. Īlthough acute complications may be severe, they are uncommon and tend to resolve completely.Īt times, IM can present as fever and adenopathy without pharyngitis.IM is usually a self-limited illness (2 to 4 wk), but symptoms of malaise and fatigue may last mo before resolving. E2) is uncommon but will occur in nearly all patients who receive ampicillin or amoxicillin due to a transient penicillin hypersensitivity. In 75% of cases there is some increase in alanine aminotransferase (ALT). Hepatomegaly with some degree of hepatitis is also common. Most patients have some degree of splenomegaly on ultrasound assessment. Splenomegaly may be palpable, most commonly during the second wk of illness. Lymphadenopathy (nonnecrotic) can be diffuse, but most commonly occurs in both the anterior and posterior triangles of the neck. Up to half of patients may have palatal petechiae. E1) is typically the most severe symptom and is characterized by white tonsillar exudates that may spread to the tongue. These patients often report the worst sore throat of their life. This is followed by the second presentation of the classic triad of pharyngitis, fever, and lymphadenopathy. The first presentation represents the prodromal period with gradual onset of fever, chills, malaise, and anorexia for several days. ![]() Following an incubation period of 4 to 7 wk, there are two common presentations.
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