Monday, April 18, 2016

Kiss and Tell

This is a peripheral blood smear from an adolescent presenting with malaise, headaches, fever, and sore throat.

Challenge: What do you expect to find on the neck exam?

Image shown under Fair Use.


RaH said...

My guess would be: mononucleosis infectiosa (Kissings disease) sore throat, lymphadenopathie (with painful neck swelling)
the blood smear shows "weird" lymphocytes (pfeiffers cells or Virocytes) these a reactive cells with atypical presentation (undifferentiated).
order a Abdominal Ultrasound, give acetaminophen/paracetamol for the pain and a xylocain spray for the soare throat. no contact sports for 4 weeks after infection.
Serologie or the EBV quick test can nail the diagnosis

Anonymous said...

tender posterior cervical nodes?

Al Bundy said...

those look like Downy cells! :) Posterior cervical lymphadenopathy, probably splenomegally.

Craig Chen said...

yep! thanks for the comments
Kiss and Tell

The peripheral blood smear shows atypical lymphocytosis. Along with the clinical picture and the patient’s age, infectious mononucleosis is the likely diagnosis. On neck exam, you may expect symmetric posterior cervical lymphadenopathy.

Source: UpToDate.