19 Year Old Female With Sore Throat

A 19 year old female presents to the clinic with the complains of sore throat for 1 week. She has felt feverish and sluggish for the past 3 weeks. She denies any cough, or shortness of breath. She says she has lost her appetite and it hurts when she swallows.
On examination she has a temperature of 100.4 F and pharynx is red and inflamed. Tonsils are enlarged and she has a diffuse adenopathy , most prominent in the posterior cervical lymph nodes. Lungs are clear to auscultation. Her abdomen is tender on palpation just below the left costal margin.

What tests will you advice to help in diagnosis?

• Complete blood count with peripheral smear
• Throat culture
• Monospot test
• Liver function tests

The peripheral blood film is shown below:

Infectious mononucleosis, peripheral smear, high power showing reactive lymphocytes

The final diagnosis is Infectious Mononucleosis

Case Discussion:

Infectious mononucleosis is a disease resulting from primary infection by Epstein Barr virus. (EBV). This virus spreads through saliva and is commonly seen in young patients, however you can get it at any age. The symptoms of this disease include:

• Fever
• Sore throat 
• Swollen lymph nodes

Patients usually get better in 2 to 4 weeks. Treatment is focused on managing symptoms until the disease resolves and includes home remedies like salt water gargles, warm fluids and good rest. Over the counter analgesics are helpful in reducing the pain and fever.

One of the complications resulting from Infectious mononucleosis is enlargement of spleen which is tender on palpation. In extreme cases it may rupture and can lead to surgical emergency. patients are advised to avoid contact sports until the spleen has returned to normal size. 

Pathology:

Characteristically the peripheral blood film shows a typical lymphocytes also known as atypical mononuclear cells. It is known that these are mainly T lymphocytes which are responding to virus infected B cells. they are peomorphic with plentiful basophilic cytoplasm and prominent nucleoli. 

Thrombocytopenia may also occur as a complication of infectious mononucleosis. A similar blood film may also be seen in other conditions like primary infection by cytomegalovirus.