Constitutional illness associated with atypical lymphocytes in the blood. Clinical features

Peak incidence in adolescence: may be subclinical or acute presentation consisting of fever, lethargy, sweats, anorexia, pharyngitis, lym-146 phadenopathy (cervical>axillary>inguinal), tender splenomegaly ± hepatomegaly, palatal petechiae, maculopapular rash especially if given ampicillin. Rarely also pericarditis, myocarditis, encephalitis. Usually self-limiting illness but complications include lethargy persisting for months or years (chronic fatigue syndrome), depression, autoimmune haemolytic anaemia, thrombocytopenia, secondary infection and splenic rupture.

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