CASE  3

A 16 year-old white female presents with a two week history of sore throat and lethargy. The patient was previously healthy. She had fever to 103o F. for a few days, and saw her physician, who noted exudate and obtained a throat culture, which was negative for group A streptococcus. Her physician prescribed ampicillin for her symptoms, and after taking several doses, she developed a diffuse macular rash on her trunk and extremities. The question of penicillin allergy arose. She comes to your office because she reports that she still has low grade fever, some sore throat, and feels extremely tired and listless. Physical examination reveals an erythematous pharynx with white exudates on the tonsils, and cervical, axillary, and inguinal adenopathy. Abdominal examination reveals a palpable spleen tip. A blood count reveals a WBC of 12.0 with 20 neutrophils, 5 bands, 30 lymphocytes, 30 atypical lymphocytes which are not blasts, and 15 monocytes. Hemoglobin and platelet count are normal. A monospot test is reported as positive.

Case 3

  1. How is the virus transmitted?   Answer

  2. What is a monospot test and what other laboratory tests may be useful in confirming your preliminary diagnosis?  Answer

  3. What are the long-term consequences of infection?   Answer

  4. Are there any effective anti-viral agents that act against this virus?   Answer

  5. Is your patient likely to be re-infected? Are family members at risk for infection? What other contacts are likely to be infected?   Answer

  6. Why did the patient have a rash after Ampicillin? Should you tell her that she is allergic to the drug?  Answer

  7. What other pathogens besides EBV can result in an infectious mononucleosis illness?  Answer