Infectious Mononucleosis with Upper Airway Obstruction: when tracheotomy and tonsillectomy can be helpful

Enrico Maria Amadei,Marco Trebbi,Laura Benedettini

doi:10.31579/2692-9562/028

Abstract

Infectious mononucleosis is caused by Epstein-Barr virus, which infects more than 98% of the world's adult population. Approximately 90% of adults become antibody-positive before the age of 30. The ages of 15-24 years are the most likely time for the onset of symptoms. We report the case of a 13-year-old girl who came to our emergency department for bilateral erythematous-poltaceous tonsillitis complicated by dysphagia and dyspnea. She had a diagnosis of infectious mononucleosis. For some hours the young woman presented an inconsistency between a marked respiratory distress and the patency of her upper airways. Finally the clinical picture fell suddenly, requiring an emergency tracheotomy to ensure a patent airway. In the following days a diagnosis of a left parapharyngeal abscess was reached. A tonsillectomy with drainage of the parapharyngeal abscess was required. It is well known that infectious mononucleosis is typically a silent infection. We describe the case of a girl who risked losing her life due to aggressive infectious mononucleosis, and how we treated her. Such a complicated case has never been described in Literature.

Highlights

We describe the case of a girl who risked losing her life due to aggressive infectious mononucleosis, and how we treated her
Infectious mononucleosis (IM) is caused by Epstein-Barr virus (EBV), which infects more than 98% of the world's adult population
The rate of developing IM from primary EBV infection is estimated at 50% [4]-75% [1]

Summary

Introduction

Infectious mononucleosis (IM) is caused by Epstein-Barr virus (EBV), which infects more than 98% of the world's adult population. We present the case of a previously healthy 13-year-old girl who came to our emergency department due to persistent dysphagia and odynophagia for 5 days, despite oral betamethasone 5 mg 2 times a day She exhibited mild fever (37.2° C), exudative obstructive tonsillar hypertrophy and marked bilateral cervical lymphadenopathy. After an infectious disease consultation, antibiotic therapy with meropenem plus clindamycin was administered These were discontinued after the onset of an erythematous skin rash and because of absence of elevated indices of inflammation. The young woman was transferred from reanimation to the pediatric department after 17 days of hospitalization She presented the need for tracheal cannula for 1 month, due to the persistence of the upper airway obstruction. She was released at home after a total of 38 days of hospitalization, with continuation of speech therapy rehabilitation

Discussion

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Conclusion