Question

A 59-year-old female presented to the emergency room with a four-day history of intermittent fever, fatigue, and chills. There was no history of illicit drug use or recent travel. She noted that her urine was very dark and her stools were very light in colour. On presentation she was febrile at 39ºC, had a pulse rate of 80 beats/minute, blood pressure of 130/64 mmHg.

Biochemical results are as follows:

Laboratory investigation:

Test                                                                        Result      Reference range

Bilirubin                                               (µmol/L)           150                              ≤17

Aspartate aminotransferase (AST)    (U/L)                180                              ≤30

Alanine aminotransferase (ALT)        (U/L)                210                              ≤37

Alkaline phosphatase (ALP)               (U/L)                349                              ≤150

Albumin                                               (g/L)                 42                                35-45

Gamma-glutamyltransferase              (U/L)                466                              ≤55

Serology tests: Positive for Epstein-Barr virus and negative for HBeAg and HCV RNA.

QUESTION 1(a)

By comparing the clinical results with the reference ranges, suggest which disorder this clinical picture is likely to represent and give evidence to support your explanation.

Answer 1

Its is acute infectious mononucleosis, refers to a group of symptoms usually caused by the Epstein-Barr virus (EBV). It typically occurs in teenagers, but you can get it at any age. The virus is spread through saliva, which is why some people refer to it as “the kissing disease.”

Besides causing splenomegaly, mononucleosis (mono) can affect the liver, lymph nodes, and other body systems.

Most (ie, 80-100%) patients with acute infectious mononucleosis have elevated liver function test results. Alkaline phosphatase, aspartate aminotransferase (AST), and bilirubin levels peak 5-14 days after onset, and gamma-glutamyltransferase (GGT) levels peak at 1-3 weeks after onset.