A 4-year-old patient presented with tiredness and a normal examination. Five days later, he had a urticiform rash on the lower extremities that led to consultation.
Two days after the last visit a fever of 38.5 oC appears, it seems to be cold and tiredness has increased, persisting the rash that now affects the lower limbs, upper limbs and face.
Physical manifestation: periorbital edema and the most pronounced itching in the morning of the last 3 days.
Oral breathing with obstruction, sub-iliary and striking laterocervical lymphadenopathy, congestive tonsils, and abdominal consolidation of nasal diameter stenosis and enlarged lymph nodes 4 cm.
Guy faces.
There is no exanthema.
Neurological normal.
Axillary temperature 38oC.
The rest of the examination and cardiopulmonary auscultation are normal without signs of respiratory failure.
Analytical results
- Haemogram:
Leukocytes: 21,200 (neutrophils 2%, segmented 31%, lymphocytes 50%, monocytes 5%, lymphocyte count 9%, lymphoplasmic cells 3%), platelets 203,400/ml.
- Transaminase AST 245 and ALT 271 (mU/ ml).
- Paul Bunell: negative.
- Negative urine analysis
On the first visit, an abdominal and chest X-ray was performed: alveolar condensation that affects the LSD and corresponds to pneumonia; possible hiliar adenopathies; abdomen with moderate stenosis thorax.
Four days later, a positive agglutination test (infectious mononucleosis) was repeated.
Hb 10.6, hematocrit 31.1, MCV 78.9, leukocytes 15400 (segmented 27%, lymphocytes 60%, monocytes 5%, lymphocyte count 8%), platelets 246.800/ml.
GOT/GPT 86/114 (mU/ml).
The chest X-ray improved from the previous control (residual condensation in LSD and LMD).
Highest slopes of the first visit: exudate pharyng5; IgG: normal flora in culture; detection of Epstein: EB (V anti-anticapsid IgM antibodies 11.5)
Chest X-ray 10 days after the first visit: increased density in LSD of paramediastinal distribution associated with lower fissure displacement, suggesting segmental atelectasis probably residual to the infectious process.
Diagnosis: infectious mononucleosis with pneumonia2-6.
