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The subject came to the emergency department due to a 2-day history of bluish colored auricles. The patient had had a fever of up to 39<span class="elsevierStyleHsp" style=""></span>°<span class="elsevierStyleSmallCaps">C</span> for a week, accompanied by cough and odynophagia. After taking amoxicillin-clavulanic acid, a rash appeared on the trunk, without involvement of palms or soles. He also started with conjunctival jaundice and choluria without acholia or abdominal pain. Physical examination revealed rash, amygdala hyperemia, mild conjunctival jaundice and acrocyanosis in the auricles (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). CBC results: hemoglobin 11<span class="elsevierStyleHsp" style=""></span>g/dl, MCV 101<span class="elsevierStyleHsp" style=""></span>fl, reticulocytes 3%. Smear test: frequent activated lymphocytes. Biochemistry: normal renal function and ions, bilirubin 3.6<span class="elsevierStyleHsp" style=""></span>mg/dl, LDH 3.020<span class="elsevierStyleHsp" style=""></span>U/l, ALT 235<span class="elsevierStyleHsp" style=""></span>U/l, AST 156<span class="elsevierStyleHsp" style=""></span>U/l, GGT 486<span class="elsevierStyleHsp" style=""></span>U/l, alkaline phosphatase 217<span class="elsevierStyleHsp" style=""></span>U/l. Coagulation, urinalysis, chest X-ray and abdominal ultrasound without findings. Serologies were requested, being positive for EBV VCA IgM. Red cell aggregates were detected at room temperature by the presence of cold agglutinins. The patient responded favorably, without any new episodes (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Cold agglutinin autoimmune hemolytic anemia only occurs in 3% of EBV mononucleosis, with clinical manifestations, such as acrocyanosis, being rare.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pintos Pascual I. Mononucleosis infecciosa con manifestaciones clínicas inusuales. 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Journal Information
Vol. 149. Issue 1.
Pages e3 (July 2017)
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Vol. 149. Issue 1.
Pages e3 (July 2017)
Image in medicine
Infectious mononucleosis with unusual clinical manifestations
Mononucleosis infecciosa con manifestaciones clínicas inusuales
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Ilduara Pintos Pascual
Servicio de Medicina Interna, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
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