Mononucleosis

Patient Presentation:
K.S., a 19 yo male presents to the health clinic complaining of fever, chills, generalized malaise, fatigue and sore throat for the past 7 days. Pt states that he is unable to eat and has pain with swallowing related to sore throat. Pt reports that he is unable to walk far without feeling like he is going to collapse. Pt denies cough. Upon examination, +4 B/L swollen cervical lymph nodes. Tonsils +4 B/L with exudate. Pt had positive pharyngitis. Pt’s skin is pale and diaphoretic. Upon palpation, positive upper left-sided quadrant abdominal tenderness. Vital signs: HR: 103 bpm, BP: 126/80, T: 102.0 F, POx: 98%, RR: 28.

Differential List:
Streptococcal infection, Lyme disease, mononucleosis

Diagnosis:
Rapid Mono Spot and Rapid Strep A tests were performed. Rapid Mono Test: Positive. Rapid Strep A Test: Positive. No Mono (EBV) Titer was drawn related to rapid test results. CMP and CBC w/differential were ordered. WBC elevated. CMP was WNL. Liver function was WNL. Diagnosis: Mononucleosis and secondary infection of Streptococcal A. Streptococcal A bacterial infection is frequently concurrent with Mononucleosis viral infection.

Treatment:
Pt prescribed Amoxicillin 500mg PO q 12hrs x 10 days to treat the bacterial infection of Strep. Pt prescribed prednisone 20mg/day PO x 5 days with weaning for swollen tonsils. Pt advised to drink lots of fluids and increase rest. Pt advised to gargle salt water for sore throat (1/2 tsp. of salt and 8 oz water) 2-3x per day. Pt advised to avoid contact sports or heavy lifting for one month to protect spleen enlargement. Pt advised to not share drinks, utensils or kiss anyone.

Outcome:
Pt did not return to the health clinic for a follow-up visit. Pt contacted by phone a few weeks after initial visit and said he was feeling a lot better (no fever, no malaise, no fatigue and able to swallow without pain).