Apoorva Nanagiri, MD1, Deepail Tewari, MBBS2 1Westchester Medical Center, Scarsdale, NY; 2Maria Fareri Children's Hospital, Valhalla, NY
Introduction: Infectious mononucleosis(IM), a clinical syndrome caused by Epstein Barr virus has typical features of fever, sore throat, lymphadenopathy, and atypical lymphocytosis. Most of the disease description is in adolescents and young adults. It is documented to be largely asymptomatic in young children. Our study compares the clinical and laboratory characteristics of IM between young pediatric patients and older pediatric patients.
Methods: It is a retrospective chart review of all the immunocompetent patients diagnosed with IM using a positive Monospot test, over 15 months. The patients were divided into two groups based on their age, and the variables compared.
Results: Of the 82 patients identified, 35 patients were < 10 years of age (younger pediatric patients-YPP), and 47 were 10 years of age or older (older pediatric patients-OPP).Overall, the most common symptom was fever. It was prominently seen in YPP (82.8%) than OPP (59.5%).The incidence of other symptoms were less frequent in YPP than OPP. Lymphadenopathy was noted only in 17% of the patients in both groups. Of those who had EBV titers done, a comparable percentage of patients had positive EBV IgM. Atypical lymphocytosis is seen in about half of the patients. ALT and AST elevations were noted in 51% of OPP and in 28.1% and 35,5% respectively in YPP. On average, transaminases were 5.32 (OPP) to 5.57 (YPP) times normal. Tests evaluating for other causes of liver injury were performed in 58.3% of OPP vs 22.2% in YPP. Cholestasis was found in 1 YPP and 6 OPP. Streptococcal pharyngitis which has a similar symptomatology was evaluated for in 30(OPP) to 35%(YPP). Many patients received antibiotics without a positive throat culture. Abdominal Ultrasonograms were done only in 11.4% and 34% patients in YPP and OPP respectively.
Discussion: This study highlights clinical and laboratory differences between YPP and OPP with IM which is crucial for accurate diagnosis, monitoring, and management. We conclude that IM should be included in differential diagnosis while evaluating patients with fever regardless of age. Absence of lymphadenopathy should not dismiss the diagnosis of IM as only 17% of our patients had lymphadenopathy. Patients with IM may present with transaminases 10 or more times normal and DB 2-5 times normal. It may be reasonable to briefly delay additional testing while observing the trend. We suggest obtaining US for all patients with IM to diagnose splenomegaly and provide anticipatory guidance to prevent splenic rupture.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Apoorva Nanagiri indicated no relevant financial relationships.
Deepail Tewari indicated no relevant financial relationships.
Apoorva Nanagiri, MD1, Deepail Tewari, MBBS2. P1473 - A Comparative Single-Center Study of Clinical and Laboratory Characteristics of Infectious Mononucleosis in Young vs Older Pediatric Patients, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
