Abdominal pain in acute infectious mononucleosis

Case report

A previously fit 20 year old man was admitted with a three day history of fever, sore throat, dyspnoea, and malaise. Ten days before admission he had fallen on to his left side and had attended the casualty department with pain over the left chest wall. A chest radiograph did not show a fracture, but the pain had been sufficiently severe to warrant overnight observation in the casualty department.

On admission he was feverish, with a temperature of 39.7°C, and had generalised lymphadenopathy, non-exudative pharyngitis, mild hepatomegaly, and splenomegaly of 2 cm. He looked pale but well, and his blood pressure was 115/95 mm Hg, with a pulse rate of 96 beats/min. He had mild left and right hypochondrial tenderness without guarding.

Initial investigations showed a haemoglobin concentration of 10.9 g/dl, and a total leukocyte …