A four-year-old female patient, with no relevant past medical history, presented with bilateral pleural edema without other accompanying symptoms.
The examination showed no hepatomegaly.
The apexification detected bilateral angle-mandibular adenopathies with inflammatory characteristics, a finding that has not previously warned the family, not presenting other relevant findings in the rest of the exploration.
Several analytical studies are performed including urine sediment, blood count, liver profile and serology for EBV and CMV.
Expectant management was maintained pending the outcome.
Four to five days after the first consultation, the patient developed high-grade fever and was reassessed again. The patient was referred to as having bilateral hepatomegaly and scleromegaly 2 cm and 1 cm from the costal margin respectively.
The following analytical results were obtained: normal urine sediment, abnormal biochemical liver profile (elevation of AST [97 IU/L], ALT [89 IU/L 85] and leukocytes [89 % alkaline phosphatase]) [292 UI/89]).
In peripheral blood smear 25% of activated lymphocytes are detected, compatible with mononucleic syndrome.
Finally, serology revealed an acute EBV infection with positive IgM for EBV and negativity in the study of CMV infection.
A monoetiological syndrome with EBV is therefore confirmed.
