Emma Yin
Age: 15
Sex: Female
Patient History
Emma, a 15-year-old student has presented to her General Practitioner with a fever, sore throat and swellings in her neck. She also complained of tiredness, loss of appetite, headache.
Full Blood Count
The results showed increased numbers of lymphocytes in the blood (> 50% of white blood cells).
| Investigation Name | Investigation Result | Normal Reference Range | Units |
|---|---|---|---|
| Haemoglobin | 118 | 120 - 150 | g/L |
| WCC | 8.9 | 4 - 11 | 109/L |
| Platelet count | 181 | 150 - 400 | 109/L |
WCC differential |
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| Cell Type | Value | Normal Reference Range | Units |
| Neutrophils | 2.0 | 1.5 - 3.5 | 109/L |
| Lymphocytes | 6.2 | 1.2 - 3.5 | 109/L |
| Monocytes | 0.6 | 0.2 - 1.0 | 109/L |
| Nucleated red blood cells | 0.0 | 0.0 - 0.0 | 109/L |
Examination of a blood film under the microscope showed atypical lymphocytes. The image below shows the presence of atypical lymphocytes among the red cells.
They are enlarged with increased cytoplasm and irregular-shaped nuclei. The term mononucleosis indicates the presence of increased numbers of lymphocytes and/or monocytes in the blood.
Liver Function Tests
Liver function tests show raised alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Bilirubin was normal.
| Investigation Name | Investigation Result | Normal Range | Units |
|---|---|---|---|
| Alanine aminotransferase (ALT) | 95 | 13 - 35 | U/L |
| Aspartate aminotransferase (AST) | 80 | 20 - 45 | U/L |
| Bilirubin | 15 | 3 - 17 | umol/L |
| Alkaline phosphatase | 125 | 30 - 200 | U/L |
Bacterial Throat Swab
The bacterial throat swab showed the presence of commensals only.
Virology / Serology
The finding of atypical lymphocytosis and mild hepatitis prompted a “monospot” test for heterophile antibodies. This test can confirm the diagnosis of Infectious Mononucleosis (IM) caused by the Epstein-Barr Virus (EBV).
As the monospot result was negative, EBV-specific serology was done. This comprises tests for antibodies to the EBV viral capsid antigen (VCA), and Epstein-Barr nuclear antigen (EBNA). See results below:
| EBV serology panel | Result |
|---|---|
| VCA IgM | Detected |
| VCA IgG | Equivocal |
| EBNA IgG | Not Detected |