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Young female patient with bilateral periorbital edema

Published:March 05, 2020DOI:https://doi.org/10.1016/j.ejim.2020.02.013
      A 19-year-old female patient presented to the emergency department with a one-week history of fever, malaise, and progressive eyelid swelling. She had no remarkable past medical history and seemed at ease during her consultation. A physical examination showed the following: blood pressure, 139/82 mm Hg; heart rate, 81/min; temperature, 37.9 °C (100.2 °F); respiratory rate, 16/min; and oxygen saturation, 98% on room air. Marked bilateral periorbital edema (Fig. 1A) and posterior cervical lymphadenopathy were observed. The edema was localized in the eyelids. No peripheral edema was found, including in the lower extremities. Ultrasound revealed splenomegaly. A blood test showed an elevated white blood cell count (11,800/μL) and mild liver dysfunction. A peripheral blood smear showed lymphocytosis with a significant increase in atypical lymphocytes (17.0% of total lymphocytes). IgM and IgG antibody titers to Epstein-Barr viral capsid antigen (VCA) were elevated, but IgG antibody to Epstein-Barr virus nuclear antigen (EBNA) was negative.
      Fig 1
      Fig. 1A. Arrows show periorbital edema in infectious mononucleosis, also known as Hoagland's sign. B. Eyelids after recovery.
      Fig 1
      Fig. 1A. Arrows show periorbital edema in infectious mononucleosis, also known as Hoagland's sign. B. Eyelids after recovery.

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