Start practicing

Pathology · patient case question

What is the most likely diagnosis and causative organism?

Patient case: Child with lymphadenopathy and petechiae

Patient: Child

Chief complaint: Sore throat, fatigue and swollen glands.

Background: Several weeks of malaise.

Current findings: Generalised lymphadenopathy and palatal petechiae.

  1. Acute leukaemia
  2. Infectious mononucleosis caused by Epstein–Barr virus
  3. Herpangina caused by coxsackievirus A
  4. Primary herpetic gingivostomatitis caused by HSV-1
Show answer and explanation

Correct answer: B. Infectious mononucleosis caused by Epstein–Barr virus

  • A. Leukaemia is an important differential given the petechiae and lymphadenopathy, and must be excluded, but the overall picture here fits mononucleosis.
  • B. CORRECT. The combination of fatigue, generalised lymphadenopathy and PALATAL PETECHIAE is classic INFECTIOUS MONONUCLEOSIS, caused by EPSTEIN–BARR VIRUS. Splenomegaly and atypical lymphocytes on the blood film complete the picture, and the monospot test confirms it.
  • C. Herpangina produces vesicles and ulcers confined to the SOFT palate and oropharynx, without generalised lymphadenopathy.
  • D. Primary herpetic gingivostomatitis presents with acutely inflamed marginal gingiva and vesicles that ulcerate, mainly in toddlers.

Note: Clinical caution: avoid contact sport in acute mononucleosis because of the risk of splenic rupture. Ampicillin or amoxicillin given in mononucleosis produces a characteristic rash.

Practice Pathology questions Pathology study notes

More Pathology practice questions