Case 6

Question 1

A 19-year-old patient P. went to the polyclinic. During the examination, the patient complained of a rise in body temperature, weakness, lack of appetite, drowsiness, nasal congestion, and lumps on the left and right sides of the neck. Objective findings: the patient’s condition was of moderate severity, body temperature was 38.9 C. The skin was clear, of normal color. Palpation in the neck area detected enlarged and moderately tender lymph nodes (including posterior ones), they were firm and elastic. Axillary and inguinal lymph nodes were also enlarged. Diffuse hyperemia of the oropharyngeal mucosa, as well as hyperemia and swelling of the tonsils were noted. The liver and spleen were enlarged. The hemogram: leukocytes – 9.0 g / l, segmented neutrophils – 17%, band cells– 2%, lymphocytes – 64%, monocytes – 17%, eosinophils – 0%, atypical mononuclear cells (15%), ESR – 20 mm / hour. Task 1. Make a clinical diagnosis and provide its justification. 2. Make a plan of specific tests and name diagnostic markers of this disease. 3. Determine the tactics of disease management. 4. Name possible outcomes of the infection in this case.

Answer 1

common infectious mononucleosis, moderate severity.

The patient’s symptoms, including fever, weakness, lack of appetite, and enlarged lymph nodes, are consistent with infectious mononucleosis. The presence of diffuse hyperemia of the oropharyngeal mucosa and atypical mononuclear cells in the blood further support this diagnosis.

Question 2

Make a plan of specific tests and name diagnostic markers of this disease.

Answer 2

The patient should be tested for infectious mononucleosis using serological tests, such as the heterophile antibody test or the Epstein-Barr virus (EBV) serology test. Diagnostic markers of infectious mononucleosis include the presence of atypical lymphocytes and elevated levels of liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

Question 3

Determine the tactics of disease management.

Answer 3

Tactics of disease management:
It’s self limiting,
Resolves in 3 to 4 weeks
The patient should be advised to rest and stay hydrated.
Symptomatic treatment with antipyretics, analgesics, and anti-inflammatory medications may be provided.

Corticosteroids may be considered in severe cases to reduce inflammation and swelling.

Antibiotics should not be prescribed, as infectious mononucleosis is caused by a virus and antibiotics are not effective against viral infections.

Question 4

Name possible outcomes of the infection in this case.

Answer 4

: In most cases, infectious mononucleosis is a self-limiting disease that resolves within a few weeks. However, in rare cases, complications such as airway obstruction, splenic rupture, or neurological complications may occur. Aplastic Anemia, Hodgkin lymphoma can also occur.
Patients with infectious mononucleosis should avoid contact sports and heavy lifting for several weeks to prevent the risk