Infectious mononucleosis is usually caused by Epstein-Barr virus and spreads through saliva, mostly among teens and young adults. It causes fever, sore throat and swollen glands, and the enlarged spleen can rupture with trauma.
Key symptoms
- Fever and severe sore throat
- Swollen glands in the neck
- Marked fatigue that can last weeks
- Headache and body aches
- Rash after taking amoxicillin
What you find on exam
- Enlarged tonsils with white exudate
- Tiny red spots on the palate
- Swollen nodes in the back of the neck
- Enlarged spleen; palpate gently
- Mild jaundice or puffy eyelids
Tests
- Blood count: high lymphocytes with atypical lymphocytes
- Heterophile antibody (Monospot) test, often negative in the first week
- EBV antibodies (VCA IgM) if Monospot is negative
- Liver tests; rapid strep test to rule out strep throat
Treatment basics
- Rest, fluids and acetaminophen or ibuprofen
- No contact sports or heavy lifting for at least 3 to 4 weeks
- Avoid amoxicillin and ampicillin
- Steroids only for airway narrowing or severe anemia or low platelets
- No antivirals; gradual return to activity
Red flags
- Sudden left upper abdominal or left shoulder pain with dizziness
- Drooling, stridor or unable to swallow
- Jaundice, bleeding or confusion
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.