Acute mononucleosis or acute glandular fever is an infectious disease characterized by fever, lymphadenopathy, a mononucleosis, and an increased titer for sheep cell agglutinins. Pfeiffer in 1889 described an epidemic disease of children which he called “Drusenfieber,” characterized by fever and enlargement and tenderness of the cervical lymph nodes. In 1922 Longcope described a syndrome closely related to the one described by Pfeiffer and, because of the associated mononucleosis, recommended the term “infectious mononucleosis,” which Sprunt and Evans had previously suggested. Acute mononucleosis occurs mainly in children and young adults, and is believed to be contagious, but no causative agent bas been definitely isolated. Some believe it to be a fusospirochetal infection. Sectioned lymph nodes show hyperplasia of the lymphoid tissue. The spleen may become palpable and tender. The unusual features of the disease are the mononuclear leukocytosis with an absolute reduction in the number of polynuclear granular cells to from 2,000 to 4,000 per cu. mm., and the specific agglutination test (heterophile test) which is practically pathognomonic in high titers, especially if no serum has previously been administered to the patient. The term “heterophile” was applied by Landsteiner to reactions of antibodies with antigens which are not related in their origin, and was based on the Forssman principle, i.e., the existence of serological relationships between substances in the cells of animals widely separated in the zoological system. Abdominal symptoms in acute mononucleosis are not unusual, and an occasional case has been reported in which they have been predominant. The following case, in which we think lymphadenopathy was demonstrated roentgenographically, was of purely abdominal type. Case Report A male nurse, twenty years of age, presented himself for treatment on Aug. 17, 1939, with a history of diarrhea and diffuse pains in the upper abdomen for three days. Physical examination showed a soft, flat abdomen with slight deep tenderness in the upper quadrants. A blood count showed a total of 5,900 white cells per cu. mm., with a normal differential count, in which the mononuclear cells amounted to 1 per cent. Under routine treatment the diarrhea ceased, but the pain persisted. Gastro-intestinal roentgen studies, on Sept. 5, showed no intrinsic lesion of the stomach or duodenum. There was a slight “ironing out” of the rugae along the inner concave border of the descending duodenum with slight displacement of this part of the duodenum toward the right and posteriorly, suggestive of a space-occupying mass in the region of the pancreatic head. Extrinsic pressure defects were evident on the inferior aspect of the left half of the transverse colon, due to a lobulated mass.
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