Mononucleosis

Dr Owen Kang and Dr Matt A. Morgan et al.

Mononucleosis is the term for infection with Epstein Barr Virus (EBV). The infection classically occurs in teenagers and young adults. It usually is diagnosed clinically and with serum lab work, but also may have suggestive imaging findings.

Exposure to EBV, but symptoms are often subclinical, especially in children. Young adults (15-24) are more likely to be symptomatic.

It was originally called "mononucleosis" after abnormal mononuclear cells were found in patients with the clinical syndrome.

EBV is in the herpesvirus class. It is thought to be spread primarily through a person-to-person route through salivary secretions. The EBV virus infects B-cells in the lymphoid tissue. Like other herpes viruses, it becomes a lifelong chronic infection with periodic shedding of virus.

Elevated transamines are possible.

Diagnosis is usually through serum labwork which would show lymphocytosis and a positive heterophile antibody test. Imaging is usually not necessary, but certain findings on imaging can be suggestive:

CT
  • splenomegaly
    • possible splenic rupture
    • splenic infarct has been reported 3
  • generalized lymphadenopathy, including cervical lymphadenopathy
  • tonsillar enlargement
  • possible hepatomegaly

Symptomatic therapy is usually sufficient. Athletes are encouraged to discontinue sports during the acute phase (<3-4 weeks) to lower the risk of splenic rupture 2.

Imaging differential diagnoses include:

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Article information

rID: 34448
System: Haematology
Synonyms or Alternate Spellings:
  • Infectious mononucleosis

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