Fever of up to 40°C since the day before admission, cough, no shortness of breath. Awoke from sleep due to chest pain.
Bloodwork was remarkable for mild thrombocytopenia, mildly elevated ALT and AST, LDH 792 IU/L, and CRP 44 mg/L. A day later, LDH rose to 872 IU/L and CRP rose to 82 mg/L.
Imaging showed significant splenomegaly and abdominal adenopathy. Although the differential diagnosis for splenomegaly and adenopathy includes lymphoma, the clinical signs and bloodwork tipped the scales in favor of infectious mononucleosis, as did the periportal tracking and edematous gallbladder, signifying inflammation; in this case, acute hepatitis.
Serology for Epstein-Barr virus (EBV) came back positive (IgM, IgG and EBNA-IgG).
The child was treated symptomatically and improved spontaneously.