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 Case 2.1 Infectious mononucleosis

A 20-year-old carpet fitter presented with a 1-week history of a sore throat, stiffness and tenderness of his neck, and extreme malaise. On examination, he was mildly pyrexial with posterior cervical lymphadenopathy, palatal petechiae and pharyngeal inflammation without an exudate. Abdominal examination showed mild splenomegaly. There was no evidence of a skin rash or jaundice.

The clinical diagnosis of infectious mononucleosis ('glandular fever') was confirmed on investigation. His white cell count was 13 x 109/l (NR 4-10 x 109/l) with over 50% of the lymphocytes showing atypical morphology ('atypical lymphocytosis'). His serum contained IgM antibodies to Epstein-Barr viral capsid antigen (VCA), the most specific test for acute infectious mononucleosis (see Table 2.2). Liver function tests were normal.

He was treated symptomatically and was advised to avoid sporting activity until his splenomegaly had completely resolved, because of the danger of splenic rupture. Many patients show clinical or biochemical evidence of liver involvement and are recommended to abstain from alcohol for at least 6 months.

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