Because the patient did not have acute IM and was no longer ill, he needed no treatment or follow-up. He was cleared for practice, though the team's hopes of qualifying for the regionals and sectionals were crushed. The clinical presentation of IM has been described as a classic triad of fever, pharyngitis, and lymphadenopathy accompanied by an enlarged spleen or liver. The disease rarely produces a prominent cough, abdominal pain, diarrhea, arthralgia, rhinorrhea, or chest pain. Mild and transient neutropenia and thrombocytopenia are common, as is mild hepatitis with double or triple the normal levels of serum aminotransferases, alkaline phosphatase, and lactate dehydrogenase.
Serum bilirubin is generally only mildly elevated.
Because these studies were all normal in this patient, his initial diagnosis was questioned. Cytomegalovirus infection, the illness that most closely mimics IM, can produce splenomegaly, hepatomegaly, and atypical lymphocytosis. This patient most likely had a viral infection. Serology Issues EBV is a ubiquitous herpes virus that invades oropharyngeal epithelial cells and B lymphocytes. The appearance of an antibody correlates with the phase of viral replication during which the antigens are elaborated.