fever
malaise
fatigue may be profound initially, but usually settles after a variable period but often takes 3 months, but may be longer in some resulting in
Chronic fatigue syndrome
pharyngitis - often pustular with bilateral large inflamed “kissing” tonsils which may compromise airway, and later, palatial petechiae (these also can occur in Strept tonsillitis)
generalised
lymphadenopathy - in particular, the finding of
posterior cervical LN's helps differentiate it from bacterial tonsillitis which generally only causes anterior cervical lymphadenitis, but adenitis is uncommon in the elderly who mainly present with an anicteric viral
hepatitis.
splenomegaly may be present but usually returns to normal by 3 weeks
abnormal LFTs are common but jaundice occurs in < 10% of young adults and in ~30% of the elderly with acute EBV
early, transient, faint macular rash is common but easily missed
early and transient bilateral upper-lid edema
widespread macular rash may occur, but particularly likely if the patient has received amoxycillin
leukocytosis, rather than leukopenia, often with atypical lymphocytes > 20% +/- thrombocytopenia
Monospot IM screen may be negative in the first week or two and overall has a sensitivity of 85% (in children over age 2yrs) and specificity of 100%
ESR is usually raised (but is not so in Strep tonsillitis!)
rarely may cause:
pancreatitis
acalculous cholecystitis
myocarditis
mesenteric adenitis
myositis
glomerulonephritis
optic neuritis
transverse myelitis
aseptic meningitis
encephalitis
meningoencephalitis
cranial nerve (CN) palsies (particularly CN VII)
Guillain-Barré syndrome
selective immunodeficiency to EBV, which occurs in persons with X-linked lymphoproliferative syndrome, may result in severe, prolonged, or even fatal infectious mononucleosis
fatal hepatic necrosis is a rare complication, and is more likely in males