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History of Present Illness:
This is a 22-year-old female who presents during an influenza epidemic for generalized weakness, fever, nausea and body aches for approximately 7 days. She denies any abdominal pain, runny nose, cough, sore throat or other complaints.
Vital Signs & Physical Exam:
Vital signs are normal except for a pulse of 120. Physical exam is otherwise normal but she is in the hallway.
Initial Differential Diagnosis:
- Syphilis, the great imitator
Initial Diagnostic Testing:
- CBC: normal except for WBC = 3.2 and platelets = 82
- Chem: normal except for direct bili 2.2, ALT = 502, AST = 402 and alk-phos = 402
- Imaging: US shows no stones but fatty liver and splenomegally
QUESTIONS:
- What do the lab results suggest?
- What should you do next?
- Want a 1-minute consult/tutorial on this case?
- Want to know what happened with this patient?
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ANSWERS:
- What do the lab results suggest? Mononucleosis
- What should you do next? Look in her throat to see that despite no sore throat, there is exudative tonsillitis, then send home with activity/splenic precautions, antiemetics, supportive care and close f/u
- Want a 1-minute consult/tutorial on this case? See yellow area from sample page below.
- Want to know what happened with this patient? Atypical lymphs = 12, Monospot: negative, see send out labs and case conclusion below.
1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook
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CASE CONCLUSION: EBV IgM: highly positive, EBV IgG: high normal
CASE LESSONS:
- Never
- Always