Unusual complications of infectious mononucleosis

Q: Describe atypical complications associated with infectious mononucleosis (IM).

Answer: 

Although most of the patients with IM recover in a week or two with supportive care, and are left with fatigue for another few weeks, a few patients may end up having potentially acute and sub-acute fatal complications such as:

• Airway obstruction
• Splenic rupture 
• Hemophagocytic lymphohistiocytosis (HLH) 
• Fulminant liver failure
• Severe hemolytic or aplastic anemia

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References:

1. Lloyd AM, Reilly BK. Infectious Mononucleosis and Upper Airway Obstruction: Intracapsular Tonsillectomy and Adenoidectomy With Microdebrider for Prompt Relief. Ear Nose Throat J. 2021 Dec;100(10_suppl):958S-960S. doi: 10.1177/0145561320930046. Epub 2020 Jun 8. PMID: 32511006.

2. Bartlett A, Williams R, Hilton M. Splenic rupture in infectious mononucleosis: A systematic review of published case reports. Injury 2016; 47:531.

3. Huang R, Wu D, Wang L, Liu P, Zhu X, Huang L, Chen M, Lv X. A predictive model for Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis. Front Immunol. 2024 Dec 5;15:1503118. doi: 10.3389/fimmu.2024.1503118. PMID: 39703509; PMCID: PMC11655318.

4. Seog WJ, Steinberg J, Ghafary I, Clores M, Aroniadis O. Severe Acute Liver Injury From Hemophagocytic Lymphohistiocytosis Related to Disseminated Herpes Simplex Virus Type 1 in a Young Immunocompetent Man. ACG Case Rep J. 2025 Jan 4;12(1):e01581. doi: 10.14309/crj.0000000000001581. PMID: 39764152; PMCID: PMC11703433.