Agranulocytosis occurrence following recent acute infectious mononucleosis

• Published in: The American journal of emergency medicine Vol. 35; no. 5; pp. 803.e5 - 803.e6
• Main Authors: Massoll, Anthony F, Powers, Stanlyn, Betten, David P
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017; Elsevier Limited
• Subjects: Abdomen; Accident prevention; Adolescent; Agranulocytosis; Agranulocytosis - drug therapy; Agranulocytosis - etiology; Agranulocytosis - therapy; Anemia; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antibodies; Antineutrophil cytoplasmic antibodies; Aplastic anemia; Arthritis; Assaying; Bacteria; Blood pressure; Bone marrow; Case reports; Cytotoxicity; Disease Progression; Emergency; Emergency medical care; Epstein-Barr virus; Epstein-Barr Virus Infections - complications; Epstein-Barr Virus Infections - drug therapy; Fatigue; Female; Fever; Fever - etiology; Granulocytes; Heart diseases; Humans; Immunoglobulin G; Immunoglobulin M; Immunoglobulins; Incidence; Infections; Infectious mononucleosis; Infectious Mononucleosis - complications; Infectious Mononucleosis - drug therapy; Laboratories; Laboratory tests; Leukocytes (basophilic); Lymphocytes B; Myelitis; Neutropenia; Neutrophils; Pain; Penicillanic Acid - analogs & derivatives; Penicillanic Acid - therapeutic use; Piperacillin - therapeutic use; Pneumonia; Skull; Temperature effects; Treatment Failure; Urine; neutropenia; Epstein Barr virus; agranulocytosis; infectious mononucleosis; Epstein-Barr virus; Infectious mononucleosis; Agranulocytosis; Neutropenia
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2016.11.042

Abstract Infectious Mononucleosis secondary to Epstein-Barr virus typically follows a relatively benign and self-limited course. A small subset of individuals may develop further progression of disease including hematologic, neurologic, and cardiac abnormalities. A mild transient neutropenia occurring during the first weeks of acute infection is a common finding however in rare cases a more profound neutropenia and agranulocytosis may occur up to 6 weeks following the onset of initial symptoms. We describe the case of an 18-year-old woman who presented 26 days following an acute infectious mononucleosis diagnosis with agranulocytosis and fever. No source of infection was identified and the patient had rapid improvement in her symptoms and resolution of her neutropenia. The presence of fever recurrence and other non-specific symptoms in individuals 2–6 weeks following acute infectious mononucleosis symptom onset may warrant further assessment for this uncommon event.