Patient: 31 month-old boy
|
Source: Hong Kong, 2001
|
| Presenting features: |
| |
Swinging and protracted fever for 26 days |
| |
Treated for "throat infection", including several antibiotics |
| |
No visible skin rash, some cervical lymph nodes +.
|
| When assessed (on Day 26): |
| |
Temp 39.5 C |
| |
Generalised mildly enlarged lymph nodes ( neck, axillae, groins ) Firm
spleen tip 2 cm, liver 1 1/2 cm
|
| Relevant Investigations: |
| |
| Hypochromic microcytic RBCs ( identified to be Thalassaemia-trait ) |
| EBV titres: compatible with convalescence from recent
infection - |
| |
Anti-bodies (IgG) to: EBNA-1p72+++, VCAp18++, VCAp23++, EAp138+,
EAp54+
|
|
CMV negative
|
|
| Diagnosis: |
| |
Ebstein-Barr Virus Infection
|
| Progress: |
| |
symptoms subsided in 2 days with no active treatment
|
| Lessons: |
| 1) |
Atypical Infectious Mononucleosis Syndrome ( not
adolescent , no skin rash, tonsils and lymph node enlargement not particularly
prominent )
|
| 2) |
Occurrence in early age - probably
due to environmental, living or eating habits. |