Wednesday, February 15, 2017

A 19 Year Old Woman With Fever And Sore Throat

A 19-yr-old woman presents with a severe sore throat, fever and malaise. She has marked cervical lymphadenopathy, gross splenomegaly and scattered petechiae on the soft palate, with enlarged tonsils covered by a confluent white exudate.


Her White cell count is mildly elevated, her serum ALT and AST concentrations are twice normal and her ALP is slightly elevated.
Which one of the following investigations is most likely to help guide your management?
A. FNA of a LN
B. HBsAg
C. CMV IgM
D. Heterophilic antibodies
E. HIV test

Answer:
D. Heterophilic antibodies

Discussion: The Hx is strongly suggestive of infectious mononucleosis, which can be confirmed by a
heterophilic antibody test (Monospot). Around 80% of pts at this stage of the illness will have a
positive test. However, if the Monospot test is negative, it should be repeated a few days later.
Specific serological tests to detect the presence of Epstein–Barr virus should be requested if it
is still negative and there is a high clinical suspicion of glandular fever. If the EBV tests are
negative then other causes for heterophilic negative acute mononucleosis – including HIV, CMV
and toxoplasmosis – should be considered. The LFTs are not sufficiently elevated in this Pt for
acute viral hepatitis. Other features of a systemic viral infection are present and therefore there
is no indication for requesting Lymph node aspiration. Clearly, management of this Pt depends on a correct diagnosis. The most frequent misdiagnosis is of bacterial tonsillitis and antibiotic Rx given to someone with glandular fever might result in a severe drug reaction. Confirmation of glandular fever would suggest the need for corticosteroid management of this Pt who is toxic and has profound
thrombocytopenia. It would be unusual for the acute HIV retroviral syndrome to present with
marked exudative tonsillitis and splenomegaly, although a reported sexual Hx negative for risk factors does not exclude HIV infection.

4 comments:

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  2. I feel so excited today because it's just a year since I got my breakthrough from Herpes.I was diagnosed of HSV1 on the 12/4/2015 and latter i got affected with the HSV2. That was my 2nd outbreak after i lost my ex fiance that got me affected with the virus. I was so scared when he died and what i heard about the Herpes virus as he's deathly and such has no cure. I feel so pity and and a disgrace to my personality,in my career and my family to have been in with the deathly sickness, and that would makes my love ones siblings stay far from me. I was going to my regular church activities when i begin to hear testimonies of how people get cure online, i never gave it a thought till my cousin Stephanie who was affected with HIV told me, Lenny you need not to worry cos i met i man today online , i traditional herbal healer whom two of her friends confirmed he cure them with his herbal herbs that i should give it a try. I saw the interest in her and she did contact the herbal doctor again in my present, luckily for me he picked and show up himself, behold he was at about to attain to some patients that have came back with appreciation of how he cure them from Cancer, HIV, and off much too the herpes he cured an 18 years old daughter.
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