Ulcers on palate, splenomegaly and lymphadenopathy with positive heterophile agglutination test

 # A 20-year-old female reports with ulcers on palate, splenomegaly and lymphadenopathy. Serum examination reveals positive heterophile agglutination test. What is the diagnosis? 
A. Rickettsia 
B. Measles 
C. Infectious Mononucleosis 
D. Chicken pox 

The correct answer is C. Infectious mononucleosis.

• It is also called Glandular fever, kissing disease.

Clinical features: 
• Age: Children or young adults with peak incidence 15-20 yrs. In children, most cases are asymptomatic. 
• Fever, sore throat, headache, chills, nausea, vomiting, lymphadenopathy & hepatosplenomegaly are present. 
• Cervical lymph nodes are usually the 1st to exhibit enlargement. 

Oral manifestation: 
• Acute gingivitis & stomatitis present. 
• White grey membrane formation on various areas of oral & pharyngeal mucosa occurs. 
• Palatal Petechiae are often diagnostic. 
- Pin-point in size. 
- Present especially on soft palate & its junction with hard palate. 
- May help as an early diagnostic sign. 

Lab findings: 
• +ve Paul Bunnel test (Heterophile 'Ab' test) 
- Characteristic & pathognomonic of disease
- Heterophile 'Ab' titre increased up to 1: 4096 
• Atypical lymphocytosis: More than 50% lymphocytosis of which > 10% atypical 
• Thrombocytopenia 
• Antibodies to EBV present 
• Normal ESR 

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