Introduction: Infectious mononucleosis is one of the most common syndromes in our clinical practice. It is characterized by elevated temperature, pharyngitis and generalized lymphadenopathy. Objectives: To describe a clinical charachteristics of infectious mononucleosis (IM) caused by the Epstein Barr virus (EBV) in splenectomized patients since in the literature we found insufficient data. Subjects and Methods: Retrospective analysis of medical documentation of the patient treated in the Clinic for Infectious Diseases of the University Clinical Center of Republic of Srpska. Results: We have described the case of infectious mononucleosis, caused by Epstein Barr virus in a splenectomized patient. In support of acute EBV viral infection were the presence of lymphadenopathy, pharyngitis, hepatomegaly, as well as the occurrence of a typical generalized maculopapulous rash, and positive ELISA EBV VCA IgM and anti EBV VCA / EA IgG, were reported. According to the aforementioned patient, it fulfilled most criteria for setting the diagnosis of acute EBV infectious mononucleosis. Our patient showed some atypical signs such as absence of fever during hospitalization, marked leukocytosis with lymphocytosis (with a maximum increase in leukocyte count at 37.3 x 10 9 , in the differential blood sample dominated lymphocytes with 29.96 x 10 9 (reference values 1.1-3.35), i.e. 80.3% (Ref. 20.0-46.0). Due to the maintenance of leukocytosis with lymphocytosis, the range of clinical has been extended trials (US abdomen, US neck, CT neck, chest, abdomen and pelvis, sternal puncture, hematologists' consultation). Based on the aforementioned hematologists' consultation, and post-release and recovery monitoring it is concluded that there has been no sign of acute hematologic disease but it has been just EBV-IM. Conclusion: Because of insufficient data on clinical presentation of Epstein Barr viral infections in splenectomized this we believe that this is one of the clinical variants although the possibility of individual variation cannot be excluded. Briefly, we can conclude that the immune system in the splenectomized patient can greatly modify the clinical presentation of Epstein barr viral infection, with the pathogenic mechanism that are still unclear.. However, due to the variety of clinical syndromes and the oncogenic potency of the Epstein-Barr virus, we should be extremely cautious and sometimes expand the diagnostic range beyond conventional examinations.
Većina pacijenata je imalo povišenu tjelesnu temperaturu i kašalj, znatan broj mijalgije i glavobolju, a gastrointestinalne i neurološke simptome je imao manji broj pacijenata. Uglavnom su hospitalizovani pacijenti sa komplikacijama u smislu virusne ili bakterijske pneumonije (radiološki verifikovanu pneumoniju je imalo 115 pacijenata) i pacijenti sa neurološkom simptomatologijom. Potvrdili smo influenzu PCR-om kod 78 pacijenta. Oskigenoterapiju je zahtijevalo 59, a mehaničku ventilaciju devet pacijenata. Respiratorno insuficijentni pacijenti koji na oksigenoterapiju putem maske za lice ili nazalnog katetera nisu reagovali poboljšanjem saturacije hemoglobina kiseonikom, odmah su iz prijemne ambulante Klinike za infektivne bolesti upućivani u Kliniku intenzivne medicine za nehirurške grane (KIM), a devet pacijenata je po prijemu premješteno u KIM zbog razvoja akutnog respiratornog distres sindroma (ARDS-a). Većina pacijenata je liječena antibiotikom (179), dok je antivirotikom liječeno 76 pacijenata (zbog nedostatka antivirusne terapije, a određen broj se javio značajno kasnije od preporučenog vremena za ordiniranje antivirusne terapije i to zbog komplikacija u vidu bakterijske pneumonije). Od 181 pacijenta ozdravilo je 169, a bilo je 12 smrtnih ishoda.
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