BIOL 2404 A&P Basics Case Study : Body Orientation Dr. Weis
Division of Internal Medicine and Infectious Disease
Case Summary
A previously health 42 year old man developed temperatures to 38.8°C, muscle and joint aches, fatigue, and loss of appetite. Within several days he also had diarrhea and emesis. A diagnosis of gastroenteritis was made on the fourth day of his illness.
The fever and fatigue persisted for two weeks while his enteric symptoms ceased.
Upon physical exam, his temperature was 38.2°C, blood pressure of 126/70 mm Hg, pulse of 94/min, and respirations of 18/min. Blood work was submitted and the results showed an elevated white cell count, elevated liver enzymes and bilirubin. Further test results were negative for hepatitis A, hepatitis B, and hepatitis C.
Review of past medical history revealed nothing remarkable and he had no family history of liver disease. During the third week of his illness, he presented with a temperature of 37.6°C, mild oropharyngeal erythema, and tonsillar hypertrophy. Crackles were heard at the left lung base and thoracic radiographs indicated a possible left lower lobe infiltrate. Abdominal palpation revealed hepatomegaly and his spleen was not palpable.
Further diagnostics for streptococcal infections were negative. A CBC was repeated and a manual WBC differential was requested. Normal and atypical lymphocytes were noted for the cause in the elevated white count. Liver enzymes were still slightly elevated but had improved since the last chemistry panel was done.
The atypical, bizarrely shaped lymphocytes have been reported and are different than those seen with acute leukemia. A diagnosis of mononucleosis was suspected and confirmed by a positive test for the Epstein-Barr virus (EBV). Six weeks after his illness began; the patient came in for a recheck. Physical exam and laboratory results were within normal limits.
Conclusion:
EBV can present with many unusual clinical signs in older adults verses the more typical symptoms seen in adolescents and young adults such as fever, pharyngitis, and peripheral lymphadenopathy. Less typical signs include: splenomegaly, gastritis, petechial rash, thrombocytopenia, anemia, pneumonitis, encephalitis, myelitis, seizures, and Guillan-Barre syndrome.
Besides mononucleosis, EBV has been linked as the cause of several lymphomas, gastric carcinomas, and leiomyomas.
Evidence shows that EBV has been found in up to 90% of most populations studied. Although most people are infected during childhood, fewer than 10% of children with primary EBV infection develop syndromes resembling infectious mononucleosis, therefore creating a subclinical infection. The percentage of patients with symptomatic disease increases 20%-70% during the teenage and young adult years. The virus is thought to spread mostly by exchange of saliva and mature adults contract the virus the same way as children. The percentage of mature adults who develop infectious mononucleosis is unknown.
For most individuals, infectious mononucleosis is self-limited and most symptoms resolve spontaneously within three weeks. Corticosteroids have been used to treat impending air obstruction due to tonsillar swelling.