An 18‐year‐old female with a known positive monospot presented to the emergency department with headache, abdominal pain, and intractable vomiting in the context of 10 days of low‐grade fevers and myalgias. Initial labs showed a transaminitis, thrombocytopenia, and mild anemia. Admission physical exam revealed tender cervical lymphadenopathy with right‐sided facial swelling, splenomegaly, and effusions of the wrists, knees, and ankles. She was admitted for dehydration and pain control. On the second hospital day, she developed worsening headache with photophobia as well as neck pain and stiffness. Examination revealed papilledema. A head CT was negative for any intracranial process. Lumbar puncture was then performed with an opening pressure of 33 cm H2O and closing pressure of 19 cm H2O. CSF studies were not concerning for infection (nucleated cells 0, protein 14, glucose 51), and CSF culture and EBV PCR from the CSF were negative. She continued to have headache that was managed with IV pain medications, but she did not require a repeat lumbar puncture. Her papilledema ultimately resolved. Based on the modified Dandy criteria, she was diagnosed with idiopathic intracranial hypertension. EBV titers were consistent with acute infection (positive IgM, IgG, and EA IgG); serum EBV PCR was positive with 39.9 copies/μL. Additional evaluation for other potential etiologies of her presentation including acute HIV, RMSF, hemophagocytic lymphohistiocytosis, hematological malignancy, or rheumatologic processes was unrevealing. Her transaminitis peaked with AST/ALT in the low 500s and then slowly trended down and her acute hepatitis panel was negative. Her anemia and thrombocytopenia slowly improved as well. At follow‐up 3 weeks following hospitalization, she had complete resolution of her symptoms with no recurrence of headache as well as normalization of her blood counts with continued down trend in LFTs. She had no further neurologic sequelae.
Infectious mononucleosis (IM) is common among adolescents and young adults and is perhaps the best recognized clinical manifestation of acute Epstein–Barr virus (EBV) infection. Although most clinicians are familiar with the typical features of classic IM, the disease can manifest with multiple clinical variants. Headache is a common presenting symptom; however, additional neurologic syndromes are more rare. Although elevated intracranial pressure and pseudotumor cerebri have been reported as an uncommon complication of chronic active EBV infection, to our knowledge it has not been reported previously in the setting of acute EBV infection in an immunocompetent host.
Hospitalists should be aware of the potential neurologic manifestations including intracranial hypertension that can be seen as variants of infectious mononucleosis and acute EBV infection.
To cite this abstract:Sherwin J, Livingston J, Stephany A. More Than Your Typical Mono: Idiopathic Intracranial Hypertension in Acute Ebv Infection. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 321. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/more-than-your-typical-mono-idiopathic-intracranial-hypertension-in-acute-ebv-infection/. Accessed March 31, 2020.