The American journal of emergency medicine · 2025
Severe infectious mononucleosis in the older adult: A case report and review of the literature.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Mohseni Michael, Omotoso Oluyemi O, Bragg Kara
Аннотация
BACKGROUND: Epstein-Barr virus (EBV) is the causative agent for infectious mononucleosis (IM), a diagnosis classically made in adolescence and young adulthood. IM is uncommon later in life generally because of previous exposure. When the disease does affect advanced age groups, diagnostic challenges exist and delays to appropriate treatment may occur.
CASE PRESENTATION: An 86-year-old man presented to the emergency department for evaluation of severe generalized weakness for greater than one week. Significant findings in the ED consisted of thrombocytopenia, elevated liver function testing, and atypical lymphocytosis. Infectious Monospot testing was positive. Given his clinical presentation, hospitalization was required. A broad workup in the hospital setting revealed a principal diagnosis of IM based on EBV DNA quantification and EBV IgM positivity. After a weeklong hospital stay, he was discharged to inpatient rehabilitation.
DISCUSSION: This case highlights the importance of considering IM in advanced age groups who are not typically considered classic for the presentation and avoiding diagnostic closure in unrevealing workups. Although IM is rarely reported in patients beyond the third decade of life, our patient's severe fatigue and laboratory findings warranted further evaluation with immunologic studies, clinching the diagnosis.
CONCLUSION: This report illustrates the need for emergency providers to consider IM in the differential even for older adults given their potential for decompensation.
CASE PRESENTATION: An 86-year-old man presented to the emergency department for evaluation of severe generalized weakness for greater than one week. Significant findings in the ED consisted of thrombocytopenia, elevated liver function testing, and atypical lymphocytosis. Infectious Monospot testing was positive. Given his clinical presentation, hospitalization was required. A broad workup in the hospital setting revealed a principal diagnosis of IM based on EBV DNA quantification and EBV IgM positivity. After a weeklong hospital stay, he was discharged to inpatient rehabilitation.
DISCUSSION: This case highlights the importance of considering IM in advanced age groups who are not typically considered classic for the presentation and avoiding diagnostic closure in unrevealing workups. Although IM is rarely reported in patients beyond the third decade of life, our patient's severe fatigue and laboratory findings warranted further evaluation with immunologic studies, clinching the diagnosis.
CONCLUSION: This report illustrates the need for emergency providers to consider IM in the differential even for older adults given their potential for decompensation.