Eyelid oedema as an early sign of infectious mononucleosis caused by the Epstein-Barr virus

Abstract

Introduction: Infectious mononucleosis is a highly prevalent disease in children and adolescents. It is caused mainly by the Epstein-Barr virus, which is detected by immunoglobulin M serology. It is transmitted by contact, through saliva, breast milk, or sexual contact. The incubation period varies between 4 and 6 weeks, and the onset of symptoms is preceded by prodromal symptoms such as asthenia, myalgia, and low-grade fever. The typical clinical picture presents with fever, fatigue, odynophagia, pharyngitis, and lymphadenopathy. However, there are numerous little-known clinical signs reported in the scientific literature but not widely known in the medical community. Methodology: The anonymised clinical case of a patient is presented. The literature describing eyelid oedema and its association with infectious mononucleosis caused by the Epstein-Barr virus was reviewed. Results: The patient is a 7-year-old boy with typical clinical symptoms of fever, odynophagia, and exudate in the palatine tonsils, which progressed to upper airway obstruction and tonsillar phlegmon, which resolved with symptomatic management and progressed favourably. Among his presenting symptoms, the patient had bilateral eyelid oedema, a sign known as ‘Hoagland's sign’, which is little known and underreported. Discussion and Conclusion: We discuss the differential diagnoses of eyelid oedema, the importance of its differential diagnosis, and its consideration and usefulness in the diagnosis of infectious mononucleosis caused by the Epstein-Barr virus, in order to improve diagnostic accuracy and disease management, thus preventing associated complications.