Epstein-Barr mononucleosis

It must be considered in 15-25 year old patients (peak incidence) with a painful throat that takes about 7 days to reach its peak.

Clinical features

• sore throat
• prodromal fever, malaise, lethargy
• anorexia, myalgia
• nasal quality to voice
• skin rash

Examination

• petechiae on palate (not pathognomonic)
• enlarged tonsils with or without white exudates (looks, but isn’t, purulent)
• periorbital oedema
• lymphadenopathy, especially posterior cervical
• splenomegaly (50%)
• jaundice ± hepatomegaly (5-10%)

The rash

• primary rash (5%)
• secondary rash
  • with ampicillin, amoxycillin (90-100%)
  • with penicillin (50%)

Diagnosis

• blood film—atypical lymphocytes
• white cell count—absolute lymphocytosis
• heterophil antibodies
  or
  Monospot test
  or
  EBV IgM test (more specific)

Complications

Rash

Extreme lethargy