Sore throat and malaise of 22 year old woman

Symptoms

• 22 year old woman

• sore throat

• general malaise

Examination

• fine macular rash on trunk

• cervical and axillary lymphadenopathy

Investigations

• Full Blood Count (FBC)

  • lymphocytosis

  • atypical mononuclear cells

    • large T-cells activated against EBV infected cells

Differential diagnosis

• glandular fever / Epstein-Barr virus (EBV)

• HIV seroconversion

• CMV

• toxoplasmosis

Further investigations

• Serology

  • EBV

    • EBV viral capsid antigen (VCA) IgM positive

    • EBV VCA IgG negative

    • Epstein-Barr nuclear antigen (EBNA) IgG negative

    • Monospot negative

  • HIV negative

  • CMV

    • IgM negative

    • IgG positive

  • toxoplasmosis

Interpretation

• Acute Epstein-Barr infection

• Old CMV immunity

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