Infectious Mononucleosis Complicated with Bilateral Peritonsillar Abscess and Splenic Infarction

Abstract

Infectious mononucleosis (IM) due to Epstein–Barr virus (EBV) infection is usually self-limited. It presents with fever, pharyngitis, fatigue, and cervical lymph node enlargement. It is common among adolescents and young adults. Although most patients recovered without any sequelae, rare complications have been reported. We described a 28-year-old man with fever, sore throat, dysphagia, and a positive IgM viral capsid Ag (VCA Ag) for EBV infection. He was admitted and received dexamethasone. He developed bilateral peritonsillar abscess (PTA) and splenic infarction, rare complications of acute EBV infection, two days after discharge. Although early reports noted PTA might occur following dexamethasone administration, recently, no obvious evidence supports it. However, high erythrocyte sedimentation rate level in our patient might indicate bacterial superinfection, which could exacerbate with dexamethasone administration. Several mechanisms such as transient hypercoagulable state and insufficient blood supply due to splenomegaly were proposed for splenic infarction due to EBV infection. Since our patient remained asymptomatic during the disease, IM-associated splenic complications, including splenic infarction, should be kept in mind. Our patient underwent bilateral tonsillectomy and received conservative management for the splenic infarction. These two rare complications of acute EBV infection have not been reported simultaneously yet.

A Rare Manifestation of Infectious Mononucleosis Tonsillitis

“…The presence of bilateral hypoattenuating rim-enhancing fluid collections within the palatine tonsils can be due to inflammatory changes and tissue injury from IM versus intra-tonsillar abscesses, which do occur in IM tonsillitis. Peritonsillar/intra-tonsillar abscess formation in IM has been reported in less than 1% of EBV-positive patients and is more commonly present unilaterally with a central hypodensity and ring enhancement within the tonsillar capsule on CT scan [ 4 , 5 ]. A superimposed bacterial infection should be excluded, although the majority of tonsillitis cases are due to viral infections, and only 28% of patients with IM and acute tonsillitis have been reported to have positive bacterial cultures [ 6 ], with the most common bacterial infections being Staphylococcus aureus and Streptococcus pyogenes [ 7 ].…”

Clinical, Hematological, Biochemical and Radiological Characteristics for Patients With Splenic Infarction: Case Series With Literature Review

“…Infection Cytomegalovirus [6][7][8] Epstein-Barr virus [9][10][11][12][13][14][15] Infective endocarditis [16][17][18][19][20][21][22] COVID-19 [23][24][25][26][27][28][29][30][31][32][33][34][35] Dengue virus [36] Mycoplasma pneumoniae [37,38] Malaria [39,40] Scrub typhus [41,42] Aspergillus pericarditis [43] Babesiosis [44] Malignancy including neoplasm and myeloproliferative diseases…”

Epstein-Barr-Virus-assoziierte Erkrankungen bei Kindern und Jugendlichen

“…Kortikosteroide sind bei unkomplizierter IM nicht indiziert [37], kommen aber bei Atemnot wegen "kissing tonsils" zum Einsatz [5,7]. Bei Verdacht auf Peritonsillarabszess ist eine Tonsillektomie indiziert [38]. Zur Wirksamkeit von Virostatika wie Aciclovir oder Ganciclovir gibt es keine ausreichende Evidenz [39].…”