Infectious Mononucleosis

Sore throat

Step 1: View clinicals

A 1 year old boy presents with a high fever for 3 days. On the day of admission, he developed noisy breathing, while his eyelids appeared swollen. He has also been feeding poorly. His birth and medical histories are unremarkable. All immunizations (including diphtheria) are up to date. A urinalysis is found to be normal.


Step 2: Order all relevant investigations

FBC & Blood Film

Hb: 11.8 g/dL Hct: 33.1% WBC: 18,900/mm3 N: 33% - Band:1% L: 41% Platelets 221,000/mm3 Blood film: A significant number of atypical lymphocytes are seen (21%)

Throat swab for RST + culture

The rapid step test (RST) is negative. The culture reports will be available in 3 days.

Monospot test

The monospot test is negative.

EBV serology

Serology is positive for viral capsid antigen IgM


Step 3: Select appropriate management

Amoxicillin
IV fluids
Steroids
Acyclovir


Score: ★★☆