Primary Infectious Mononucleosis Masquerading as Post-operative Fever in a Young Patient with Cemento-ossifying Fibroma of the Skull Base.
epstein-barr virus infectious mononucleosis
meningitis
post-operative
post-operative fever
skull base surgery
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
08 Dec 2019
08 Dec 2019
Historique:
entrez:
16
1
2020
pubmed:
16
1
2020
medline:
16
1
2020
Statut:
epublish
Résumé
The typical presentation of infectious mononucleosis (IM) is characterized by a triad of fever, pharyngitis, and lymphadenopathy. Epstein-Barr virus (EBV) is the most common etiologic agent for IM. Humans are the reservoir for EBV, and it is transmitted via intimate contact between individuals. This case presents a 19-year-old male with recurrent cemento-ossifying fibroma of the skull base with a complicated post-operative course including bacterial meningitis, cerebrospinal fluid (CSF) leak, and intermittent fevers despite treatment with intravenous cefepime. Head computed tomography (CT) revealed a nonspecific subdural collection that could represent an empyema. However, exploratory craniotomy revealed no empyema. CT chest demonstrated bilateral hilar mediastinal lymphadenopathy and splenomegaly. Blood work for fever of unknown origin was positive for EBV immunoglobulin M, and EBV deoxyribonucleic acid 180,565 IU/mL. The diagnosis of EBV IM in this case was elusive because it presented post-operatively, symptoms aligned with the patient's CSF leak, and he reported no sexual or sick contacts. For post-operative young patients with recurrent fevers of unknown origin, it is important to consider EBV IM in the differential. Earlier diagnosis could have saved the patient unneeded tests, prevented surgical re-exploration, and resulted in a shorter hospital stay.
Identifiants
pubmed: 31938618
doi: 10.7759/cureus.6327
pmc: PMC6948092
doi:
Types de publication
Case Reports
Langues
eng
Pagination
e6327Informations de copyright
Copyright © 2019, Edelbrock et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
PLoS One. 2013 May 22;8(5):e64921
pubmed: 23717674
Pathogens. 2012 Nov 08;1(2):156-74
pubmed: 25436768
J Pediatr (Rio J). 2016 Mar-Apr;92(2):113-21
pubmed: 26802473
J Exp Med. 2017 Feb;214(2):269-283
pubmed: 28108590
Virol J. 2012 Feb 21;9:49
pubmed: 22348267
Biol Blood Marrow Transplant. 2010 Jan;16(1 Suppl):S82-9
pubmed: 19932759
Nat Rev Cancer. 2016 Dec;16(12):789-802
pubmed: 27687982
Nature. 1978 Aug 24;274(5673):756-61
pubmed: 210392
Lancet. 1969 Mar 22;1(7595):593-5
pubmed: 4180127
Lancet Oncol. 2009 Apr;10(4):321-2
pubmed: 19350698
J Am Board Fam Pract. 2001 Jul-Aug;14(4):234-42
pubmed: 11458965
Front Oncol. 2018 Jun 13;8:211
pubmed: 29951372
Blood. 1996 Jan 15;87(2):812-7
pubmed: 8555507