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[Conservative treatment of a spontaneous splenic rupture in a patient with infectious mononucleosis].

A 30-year-old man with flu-like symptoms for several weeks presented at the emergency room with pain in the left upper abdomen. There was no history of trauma. The patient had a spontaneous rupture of the spleen due to mononucleosis infectiosa. He was successfully treated with conservative management during a 7-day period of hospitalisation. Spontaneous splenic rupture is a rare but potentially lethal complication of infectious mononucleosis. Alarming symptoms are left upper abdominal pain, worsening during inspiration, and haemodynamic instability. Although splenectomy is the accepted treatment for haemodynamically unstable patients, some patients, may be adequately treated with conservative management. They should be observed during the critical phase and must comply to a period of restricted physical activity after they are discharged from the hospital. There is no consensus about the length or content of this restriction period.

Abdominal Pain↗

The coexistence of hepatitis A and infectious mononucleosis.

Hepatitis A is an acute, self-limited disease that spreads predominantly by the fecal-oral route. Hepatitis A characteristically has an acute, sudden influenza-like onset with a prominence of myalgia, headache, fever and malaise. Infectious mononucleosis is an acute illness characterized clinically by sore throat, fever and lymphadenopathy. The virus usually spreads from person to person by close contact with nasopharyngeal secretions. In this case the coexistence of both diseases in the same patient is found interesting.

Adult↗

Infectious mononucleosis progressing to fatal malignant lymphoma: a case report and review of the literature.

Epstein-Barr virus (EBV) infection is nearly ubiquitous. While most primary EBV infections aremild and self-limited, occasional patients will develop severe complications of infectious mononucleosis (IM). Potentially fatal complications include fulminant hepatic failure, virus associated hemophagocytic syndrome and lymphoproliferative disorders. We report the case of an apparently immunocompetent 21-year-old woman with IM that progressed within weeks from a polyclonal B cell proliferation to a fatal B cell lymphoma.

Adult↗

Impaired T lymphocyte colony formation in infectious mononucleosis: evidence for both monocyte and lymphocyte defects.

PHA-induced T lymphocyte colony formation in semi-solid agar culture was studied in mononuclear cells (MC) and non-adherent cells (NAC) from the blood of patients with infectious mononucleosis (IM). Colony formation expressed as number of colonies per 10(6) E-RFC or as number of colonies per ml of blood was depressed by about 90% during the first weeks of disease, but returned to normal levels during the convalescence period. Addition to the agar culture of conditioned medium prepared from adherent blood MC or normal donors partly restored colony formation by both MC andNAC from patients with IM in the acute stages, suggesting a subnormal production of conditioning factors by cocultured adherent cells. In line with this finding adherent cells from patients with acute disease failed to produce a conditioned medium which optimally supported the growth of T lymphocyte colonies from NAC of normal donors. When mononuclear cells from patients with IM were mixed with normal donor lymphocytes prior to agar seeding, colony formation by the normal cells was reduced by 10--65%. It is concluded that mononuclear cells from patients with IM have a reduced capacity to form T lymphocyte colonies in agar medium. This reduction possibly reflects a lack of production of colony stimulating factors from monocytes, but also increased activity of T lymphocyte colony suppressor cells.

Adolescent↗

[Plaut-Vincent's acute necrotizing ulcerative fusospirillum tonsillitis associated to infectious mononucleosis].

We report the case of a 14 years old girl patient with recurrent tonsillitis who had been diagnosed and admitted previously with Plaut-Vincent's angina. Six weeks after leaving the hospital she was assited in Emergencies by an infectious mononucleosis associated to unilateral tonsillar necrotizing ulceration from which a sample was taken to microbiological exam finding the fusospirochaetal complex Borrelia vincenti and Fusobacterium necrophorum. A literature review at the respect of such association and its treatment is performed.

Acute Disease↗

Soluble ICAM-1 levels in serum during acute infectious mononucleosis.

Intercellular adhesion molecule-1 (ICAM-1) has been reported as a T-cell, B-cell or macrophage/monocyte activation antigen. We investigated whether soluble ICAM-1 levels in serum increased during the acute stage in 11 patients with infectious mononucleosis (IM). Serum ICAM-1 levels were measured by a double determinant immunoassay using 2 monoclonal antibodies in the FAST system. Serum ICAM-1 levels in patients with IM increased during the acute stage. There was a positive correlation between serum ICAM-1 levels and absolute counts of peripheral blood mononuclear cells. Our results suggest that the elevated serum ICAM-1 levels are based on the increased counts of activated peripheral blood mononuclear cells and that ICAM-1 is a part of the regulatory system of immune reactions during acute IM.

Acute Disease↗