Mononucleosis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

The classic initial presentation of mononucleosis include: fever, lymphadenoapthy, pharynigitis, rash and/or periorbital oedema. Occasionally, patients infected with EBV may also display splenomegaly, with subsequent life-threatening complication of splenic rupture and/or hepatomegaly.

Physical Examination

Vitals:

• Bradycardia is a rare and inconsistent finding

Skin:

• Maculopapular rash which is generalized, non-itchy, faint and disappears rapidly may be observed during the early phase of the disease.

• Jaundice: varies with the age of presentation. Among young adults with mono ~5% of cases present with jaundice; however, among the elderly age group, ~30% present with anicteric viral hepatitis

• Anemia is uncommon, even though EBV infection induces antibodies to RBC-membranes

Eyes:

• Hoagland sign: Transient bilateral supra-orbital oedema that is observed during the early stages of infection.

Ear, Nose and Throat:

• Tender lymphadenopathy is present; in particular, the posterior cervical lymph nodes on both sides of the neck are involved.

• Pharyngitis secondary to mono may be either be exudative or non-exudative. Either type of pharyngitis is colonized by group A strep.

• White patches may also observed in the tonsils associated with massive tonsilar enlargement which may lead to fatal airway obstruction.

• Petechial hemorrhages may be observed in the posterior oropharynx; particularly involving the palate.

Abdomen:

• Tender splenomegaly is a late-feature. Following recovery from initial illness, spleen returns to normal or near normal size.
• Hepatomegaly

Atypical rare presentations

Neurological involvement:

• Encephalitis,
• Aseptic meningitis
• Transverse myelitis
• Bell's palsy
• Guillain-Barré syndrome

Cardiac involvement:

• Myocarditis

Abdominal involvement:

• Pancreatitis,
• Acalculous cholecystitis,
• Mesenteric adenitis,
• Glomerulonephritis

References

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