Infectious mononucleosis in splenectomised patient

Ljiljana Pašić, Dragan Kasapović, Milan Petrović, Zdravka Kezić, Antonija Verhaz, Snežana Ritan

Abstract


Introduction: Infectious mononucleosis is one of the most common syndromes in our clinical practice. It is characterized by elevated temperature, pharyngitis and generalized lymphadenopathy.

Objectives: To describe a clinical charachteristics of infectious mononucleosis (IM) caused by the Epstein Barr virus (EBV) in splenectomized patients since in the literature we found insufficient data.

Subjects and Methods: Retrospective analysis of medical documentation of the patient treated in the Clinic for Infectious Diseases of the University Clinical Center of Republic of Srpska.

Results: We have described the case of infectious mononucleosis, caused by Epstein Barr virus in a splenectomized patient. In support of acute EBV viral infection were the presence of lymphadenopathy, pharyngitis, hepatomegaly, as well as the occurrence of a typical generalized maculopapulous rash, and positive ELISA EBV VCA IgM and anti EBV VCA / EA IgG, were reported. According to the aforementioned patient, it fulfilled most criteria for setting the diagnosis of acute EBV infectious mononucleosis. Our patient showed some atypical signs such as absence of fever during hospitalization, marked leukocytosis with lymphocytosis (with a maximum increase in leukocyte count at 37.3 x 109, in the differential blood sample dominated lymphocytes with 29.96 x 109 (reference values 1.1-3.35), i.e. 80.3% (Ref. 20.0-46.0). Due to the maintenance of leukocytosis with lymphocytosis, the range of clinical has been extended trials (US abdomen, US neck, CT neck, chest, abdomen and pelvis, sternal puncture, hematologists' consultation). Based on the aforementioned hematologists' consultation, and post-release and recovery monitoring it is concluded that there has been no sign of acute hematologic disease but it has been just EBV-IM.

Conclusion: Because of insufficient data on clinical presentation of Epstein Barr viral infections in splenectomized this we believe that this is one of the clinical variants although the possibility of individual variation cannot be excluded. Briefly, we can conclude that the immune system in the splenectomized patient can greatly modify the clinical presentation of Epstein barr viral infection, with the pathogenic mechanism that are still unclear.. However, due to the variety of clinical syndromes and the oncogenic potency of the Epstein-Barr virus, we should be extremely cautious and sometimes expand the diagnostic range beyond conventional examinations.

 


Keywords


Infectious Mononucleosis, splenectomy, Epstein-Barr virus, clinical characteristics

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DOI: 10.5457/ams.v49i0.520