Patient was prescribed meclizine and was told to take an OTC dextrose/fructose/phosphoric acid solution for symptom management.īecause the patient’s condition continued to deteriorate, she decided to fly home. She was escorted by a friend to the clinic four days later and had labs drawn. After discharge, she had exacerbating nausea with emesis, vertigo, tension headache, mental fatigue, gait unsteadiness, and increased sleep requirements. Patient was diagnosed with a viral infection and discharged back to her dorm. Initial evaluation revealed negative rapid strep and negative monospot. Case PresentationĪ 25-year-old female graduate student presented to her Student Health Services Office with weeklong complaints of fever, sore throat, fatigue, nausea, and “dizziness.” She denied vertigo, history of migraines, recent trauma, drug/alcohol use, or exposure to ticks. Neurological complications of mononucleosis need to be considered with the diagnosis to ensure timely symptom management and appropriate assurance for the patient. This was debilitating for the patient who deteriorated from an independent graduate student to being home-bound and dependent for all IADLs. The patient in this case was older than the usual cohort and presented with early neurological complications including ataxia with later exacerbation of vertigo, difficulty in concentrating, noise sensitivity, and mental fatigue from minor tasks likely due to encephalitis with clinical presentation similar to postconcussion syndrome. These have been documented predominantly in the pediatric literature as part of a postviral syndrome. However, serious neurological manifestations including seizures, ataxia, meningitis, encephalitis, transverse myelitis, Guillain-Barre syndrome, autonomic dysfunction, anxiety, and depression can occur in about 1% of cases. In most cases, it has an insidious onset over 1-2 weeks, sometimes associated with thrombocytopenia and transaminitis, with gradual self-resolution. Mononucleosis is a viral illness which classically presents in young adults as a triad of fatigue, pharyngitis, and lymphadenopathy. Though corticosteroids and acyclovir are not recommended therapy in patients presenting with EBV-associated ataxia, clinicians may want to keep a low threshold to start these medications in case more serious neurological sequelae develop. She was started on valacyclovir and a prednisone taper, recovering by the end of twelve weeks.
The patient was clinically diagnosed with EBV-associated cerebellitis and encephalitis, displaying neurological and psychiatric impairment commonly seen in postconcussion syndrome. We present the case of a 25-year-old graduate student with weeklong complaints of fever, sore throat, fatigue, nausea, and “dizziness.” She later developed increased sleep requirements, ataxia, vertigo, and nystagmus with a positive EBV IgM titer confirming acute infectious mononucleosis. However, when they occur, appropriate treatment must be undertaken to ensure appropriate symptomatic management and reduce morbidity. There is no specific treatment for EBV.Neurological manifestations of mononucleosis are extremely rare, occurring in about 1% of all cases. You can help protect yourself by not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who have EBV infection. There is no vaccine to protect against EBV infection.
About nine out of ten of adults have antibodies that show that they have a current or past EBV infection.įor more information, see Laboratory Testing. EBV infection can be confirmed with a blood test that detects antibodies. Diagnosisĭiagnosing EBV infection can be challenging because the symptoms are similar to other illnesses. If the virus reactivates, you can potentially spread EBV to others no matter how much time has passed since the initial infection. Once the virus is in your body, it stays there in a latent (inactive) state. The first time you get infected with EBV (primary EBV infection) you can spread the virus for weeks and even before you have symptoms. The virus probably survives on an object at least as long as the object remains moist. However, EBV can also spread through blood and semen during sexual contact, blood transfusions, and organ transplantations.ĮBV can be spread by using objects, such as a toothbrush or drinking glass, that an infected person recently used. having contact with toys that children have drooled onĮBV spreads most commonly through bodily fluids, especially saliva.using the same cups, eating utensils, or toothbrushes.
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