Presentation
Fever of up to 40°C since the day before admission, cough, no shortness of breath. Awoke from sleep due to chest pain.
Patient Data
Mildly enlarged liver, impression of mild edema.
Significantly enlarged spleen, with several hypoechoic foci measuring up to 8 mm across, without internal flow.
Significant lymphadenopathy in the upper abdomen, with nodes measuring up to 2 cm in thickness.
Minimal amount of right pleural effusion.
Gallbladder contains tiny calculus.
CT abdomen done with the split bolus technique.
Mildly enlarged liver, with several tiny hypodense foci. Mild periportal tracking. Edematous gallbladder, containing a tiny calcified calculus.
Markedly enlarged spleen, with several small hypodense foci.
Pronounced abdominal lymphadenopathy - hepatogastric ligament, peripancreatic, and hepatic hilum. Numerous mesenteric and retroperitoneal lymph nodes up to borderline thickness.
Small amount of free intraperitoneal fluid in the lower abdomen-pelvis.
Case Discussion
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.