Issue 4/2023
Lyoncheva, K., Balabanska, R.,
Acibadem City Clinic Tokuda Hospital, Gastroenterology Clinic – Sofia
Infectious mononucleosis is a common infectious disease, especially in young people. It presents usually with fever, sore throat, enlarged cervical lymph nodes, and reactive hepatitis with increased liver enzymes and even direct hyperbilirubinemia can be observed. In CBC and blood smear examination, typical changes with the increase in the percentage of monocytes and atypical lymphomonocytes are observed, and serologically demonstrates IgM antibodies with a growing titer and subsequent appearance of EBV-IgG. The treatment includes immunomodulating agent Isoprinosine and the vitamins, antipyretics, sometimes an antibiotic for angina, but often the improper prescription of penicillin antibiotic Amoxicillin can lead to an erythema rash throughout the body, which is why its use is avoided. Liver involvement requires a strict dietary regimen without alcohol and fatty foods, as well as the addition of hepatoprotective treatment. In the differential diagnosis in reactive hepatitis, biliary-pancreatic pathology, acute viral hepatitis A, B, C, E, as well as drug induced liver injury (DILI) should be excluded. A case is presented of a young woman with febrile-intoxication syndrome and gastrointestinal manifestations, liver abnormalities and jaundice, mild splenomegaly and subsequent involvement of tonsils with angina and lymphadenopathy, demonstrating the course of virological examinations and dynamics in the level of antibodies (EBV VCA IgM and EBV VCA IgG), as well as rapid response of cytolytic liver enzymes. In cases of cytolysis with or without hyperbilirubinemia, infectious mononucleosis should also be taken into account in the differential diagnosis as a possible cause.
Address for correspodnce:
Lioncheva, K., Balabanska, R.
Acibadem City Clinic Tokuda Hospital,
Gastroenterological clinic – Sofia
51B, „Nikola I. Vapzarov“, Blvd.,
1407, Sofia