1/13. Non hypoxia-related splenic infarct in a patient with sickle cell trait and infectious mononucleosis.splenic infarction in patients with sickle cell trait is usually related to hypoxic conditions, while non-hypoxia-related infarcts are extremely rare. We report on a case of a 17-year-old male patient, living at sea level, who developed a severe left upper quadrant abdominal pain during the course of a febrile episode. On physical examination he had a mildly palpable but extremely painful spleen. A spleen scan revealed 2 areas of impaired radionucleide distribution. Hepatic enzymes were moderately increased and the IgM anti-EBV antibodies positive. Hemoglobin electrophoresis revealed the presence of 42% of hemoglobin S. A probable diagnosis of splenic infarction was established in a patient with sickle cell trait, during the course of infectious mononucleosis. The patient was treated symptomatically. The conditions of splenic congestion induced by the EBV infection and the high-grade fever may have contributed to splenic sequestration and subsequent infarcts.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/13. Recurrent infectious mononucleosis caused by Epstein-Barr virus with persistent splenomegaly.We present the clinical case of a 20-year-old male soldier who appeared in general good physical condition. He suffered from infectious mononucleosis caused by Epstein-Barr virus that had recurred 2 years after the first serologically documented episode. The detected splenomegaly persisted in the healthy young man, who otherwise showed no apparent immune deficiency. To our knowledge, this is an extremely rare condition.- - - - - - - - - - ranking = 0.17818951507557keywords = physical (Clic here for more details about this article) |
3/13. Atypical lymphocytosis resembling non-Hodgkin's lymphoma in peritoneal effusion of infectious mononucleosis: a case report.Peritoneal effusion appears to be an unusual complication of infectious mononucleosis (IM). The cytological features of peritoneal effusion from a patient affected by IM are presented. The patient was a 21-year-old Japanese woman, with typical and physical findings of IM. ascites disappeared with resolution of acute IM. The cytospin smears of the ascitic fluid were highly cellular, consisting exclusively of lymphoid cells. Lymphoid cells were composed of large cells with broad basophilic cytoplasm, as well as of small to medium-sized cells having scant cytoplasm and irregularly shaped nuclei. The overall cytomorphological pictures posed serious difficulties in differentiating this condition from those of peripheral T-cell lymphomas manifesting ascites. The majority of atypical lymphocytes, including large cells, expressed CD3 and CD8. The present case indicates that IM should be added to the list of lesions considered for the differential diagnosis of non-Hodgkin's lymphoma of the peritoneal fluid, particularly regarding young adults.- - - - - - - - - - ranking = 0.17818951507557keywords = physical (Clic here for more details about this article) |
4/13. Cold urticaria and infectious mononucleosis in children.Physical urticaria includes a heterogeneous group of disorders characterized by the development of urticarial lesions and/or angioedema after exposure to certain physical stimuli. The authors present the case of a child with severe acquired cold urticaria secondary to infectious mononucleosis. Avoidance of exposure to cold was recommended; prophylactic treatment with ketotifen and cetirizine was begun and a self-administered epinephrine kit was prescribed. The results of ice cube test and symptoms significantly improved. Physical urticaria, which involves complex pathogenesis, clinical course and therapy, may be potentially life threatening. Evaluation and diagnosis are especially important in children. To our knowledge this is the first description of persistent severe cold-induced urticaria associated with infectious mononucleosis in a child.- - - - - - - - - - ranking = 0.17818951507557keywords = physical (Clic here for more details about this article) |
5/13. Mononucleosis and hepatic failure associated with diphenylhydantoin treatment in an infant.Diphenylhydantoin-induced hepatitis and mononucleosis are uncommon in children. The occurrence of these two diseases in the same individual, with progression to hepatic failure is rare and has not been reported in infants. This report represents a 6-month-old male infant who developed an infectious mononucleosis-like syndrome and hepatic failure 16 days after diphenylhydantoin administration. He took this anticonvulsant for controlling seizures after a head injury. fever, skin rash, hepatosplenomegaly, lymphadenopathy, and atypical lymphocytosis led to the initial diagnosis of infectious mononucleosis. However, negative heterophil antibody did not support the diagnosis. jaundice ensued in the following course and became more and more profound. Meanwhile, physical examination showed shrinking in liver size. Negative virology studies, including Epstein-Barr virus, cytomegalovirus, and hepatitis b virus, excluded them as causative agents. The patient lapsed into a stage I hepatic coma, but gradually recovered clinically and biochemically after eight successive exchange transfusions and supportive care. Two liver biopsies were performed 20 and 50 days after the onset of disease, respectively. Remarkable hepatic parenchymal loss, cholestasis, and fatty change were found on histologic examination of the first biopsy specimen, and portal fibrosis was noted on the second.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/13. cytomegalovirus infection in the normal host.CMV mononucleosis often resembles EBV infectious mononucleosis; however, certain features of the history and physical may help to distinguish CMV from EBV. While CMV mononucleosis is usually self-limited, certain laboratory abnormalities may persist for months or years after the patient has recovered. Previous reports on CMV in the non-immunocompromised host have rarely described systemic complications. We have reviewed 10 cases of CMV with systemic manifestations at one institution over a 15-year period. These patients had prolonged fevers (often greater than three weeks) and the diagnosis was often unsuspected during the early part of the illness. While two patients required mechanical ventilation, all patients had self-limiting disease and survived. When CMV is suspected and diagnosed early in the course, numerous diagnostic (and potentially dangerous) tests can be avoided in a viral illness in which prolonged fever is common.- - - - - - - - - - ranking = 0.17818951507557keywords = physical (Clic here for more details about this article) |
7/13. Exudative ascites complicating infectious mononucleosis.A case of Epstein-Barr virus mononucleosis with the unusual complication of exudative ascites is presented. The patient was a 22-yr-old man with the typical symptoms and physical findings of hepatitis secondary to infectious mononucleosis. Extensive evaluation including liver biopsy, failed to show another cause for the patient's ascites. The ascites and hepatitis disappeared with resolution of the acute mononucleosis infection. He is well 12 months after this illness with no evidence for chronic liver disease. This case adds to the list of causes for exudative ascites associated with acute hepatitis.- - - - - - - - - - ranking = 0.17818951507557keywords = physical (Clic here for more details about this article) |
8/13. infection by human cytomegalovirus associated with chronic hematospermia.Hematospermia, or blood in the ejaculate, is not an infrequent urologic condition most often occurring without recognizable physical dysfunction. It is regarded as benign and self-resolving. In its chronic form, however, it may manifest periodic recurrences or persistence for months to years. We had opportunity to follow the course of cytomegalovirus (CMV) infection in a patient experiencing both chronic hematospermia and CMV mononucleosis. The level of virus output in urine (representing systemic CMV infection) remained constant over a period of forty-four weeks during and after convalescence from the mononucleosis syndrome. However, virus isolation from semen (representing localized CMV infection) appeared to parallel the course of and concomitantly terminate with the resolution of the urologic condition. The concentration and temporal association of CMV with the course of chronic hematospermia is suggestive of a causative role in this genital pathology.- - - - - - - - - - ranking = 0.17818951507557keywords = physical (Clic here for more details about this article) |
9/13. Surgical implications of infectious mononucleosis.A series of 50 consecutive patients admitted to the hospital with a primary diagnosis of infectious mononucleosis is reviewed, with particular emphasis on the abdominal complaints and physical findings. Forty-eight percent of the patients had abdominal pain. Abdominal symptoms were the chief complaint in 24 percent of the patients. Two cases of splenic rupture are presented. One case of spontaneous rupture of the spleen is emphasized, as there are only 18 well-documented cases of true spontaneous rupture of the spleen in infectious mononucleosis. Four young persons with infectious mononucleosis in Portland, oregon, recently bled to death at home from a ruptured spleen. Guidelines are presented to aid the surgeon in evaluating the patient with infectious mononucleosis. The risk of splenic rupture persists after the patient recovers. Recommendations are made regarding the resumption of physical activity in these young, active patients.- - - - - - - - - - ranking = 0.35637903015113keywords = physical (Clic here for more details about this article) |
10/13. The effect of social adversity on the fatigue syndrome, psychiatric disorders and physical recovery, following glandular fever.Two hundred and fifty patients attending primary care with glandular fever or an upper respiratory tract infection were studied prospectively up to 6 months after onset. Of these patients 228 were interviewed with the life Events and Difficulties Schedule and the Schedule for Affective Disorders and Schzophrenia, giving research Diagnostic Criteria for psychiatric disorders. The experience of severe social adversity (provoking agents) had a significant association with psychiatric disorder at 2 months (odds ratio = 5.3) and 6 months (odds ratio = 5.8) after onset of infection. This association was especially significant for depressive illness (odds ratio = 9.1 at 2 months and 11.9 at 6 months). In contrast, social adversity had little association with the development of the post-infectious fatigue syndrome, or delayed physical recovery. Social adversity may be an important maintaining factor for psychiatric disorders, especially depressive illness, following acute infections.- - - - - - - - - - ranking = 0.89094757537783keywords = physical (Clic here for more details about this article) |
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