The FP suspected that the patient had infectious mononucleosis caused by the Epstein-Barr virus. She performed an abdominal exam, but there was no evidence of hepatosplenomegaly. Other features of mononucleosis may include nausea, anorexia without vomiting, uvular edema, generalized symmetric lymphadenopathy, and lethargy.
The FP recommended supportive measures including ibuprofen and/or acetaminophen for pain and fever, plenty of fluids, and rest. The patient was sent to the lab for a Monospot test, and the result came back positive the following day. At that point, the FP also recommended avoidance of contact sports for the next few months because of the risk of splenic rupture associated with mononucleosis. At a follow-up appointment a week later, the patient was doing somewhat better but continued to have some fatigue, pharyngitis, and lymphadenopathy. Fortunately, this was the start of summer vacation for the student, so she was able to take time off to recuperate.
Photo courtesy of Tracey Cawthorn, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Williams, B, Usatine R, Smith M. Pharyngitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:213-219.
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