HISTORY. The patient often reveals contact with a person who has had IM. Although children have a short incubation period of about 10 days, symptoms in adults may not appear until 1 to 2 months after exposure to the EBV. The patient with suspected IM typically reports a history of fever and fatigue for 1 week, followed by a sore throat (often described as the most painful the patient has ever experienced). Other symptoms include anorexia, painful swallowing, and swelling of the lymph nodes.

PHYSICAL EXAMINATION. Note the redness of the pharynx and observe for exudate. Observe for petechiae that may appear at the junction of the hard and soft palates (occurs in 25% of patients). Note any facial edema, particularly eyelid edema. Facial edema is rarely encountered in other illnesses of young adults and is suggestive of IM. Some patients have a maculopapular rash (discolored patches of skin mixed with elevated red pimples). Palpate for enlarged lymph nodes in the cervical and epitrochlear (around the elbow) areas. Significant adenopathy is almost always present, and its absence should make one doubt the diagnosis of IM. During an abdominal examination, palpate for an enlarged spleen (occurring in 50% of patients) and liver.

PSYCHOSOCIAL. The patient with IM has viral illness that may last up to 4 weeks. Since most cases occur in college students, IM may prevent the student from performing academically at preillness levels. If the student falls behind in her or his studies, the student or parents may feel anxious or stressed. Assess the patient's ability to cope with the interference with school tasks. Determine if the patient has discussed the illness with her or his professors and if arrangements have been made to make up work or withdraw from school if needed. If the young adult is employed rather than in school, determine if the patient has told the employer of her or his healthcare needs.

Diagnostic Highlights

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