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A young man presents with a sore throat and mild abdominal discomfort. The patient reports bodyaches, chills and a fever over the past few days as well. On exam you notice an erythematous pharynx with tonsillar exudates. Additionally you palpate posterior cervical adenopathy and a fullness palpated in the left upper quadrant of the abdomen.
Although this patient presents with fever and chills along with tonsillar exudates, this patient presents with signs and symptoms that are classic for infectious mononucleosis which is a viral infection cause by Epstein-Barr Virus. Infectious mononucleosis can be managed with supportive measures and do not require antibiotics. Diagnosis is often clinical but can be confirmed with monospot (heterophile antibody testing).
Because this is a viral infection, antibiotics (Answers B & C) are not recommended and patients often resolve with support care and activity precautions such as the avoidance of contact sports given the risk of splenic rupture in the setting of splenomegaly.
Incision and Drainage (Answer D) is not recommended in infectious mononucleosis given there is usually no drainable abscess within the pharnyx as opposed to pathologies such as peritonsillar abscess.
