Infectious mononucleosis in older adults
1Temple University School of Medicine and Hospital, Philadelphia, Pennsylvania.
American Family Physician
|December 1, 1990
Summary
Primary Epstein-Barr virus infection, or infectious mononucleosis, is rare in adults over 40. Older patients often lack typical symptoms, presenting with jaundice and hepatomegaly, leading to misdiagnosis.
Area of Science:
- Infectious Diseases
- Virology
- Internal Medicine
Background:
- Primary Epstein-Barr virus (EBV) infection, commonly known as infectious mononucleosis (IM), typically affects adolescents and young adults.
- Infectious mononucleosis in older adults (over 40) is an uncommon presentation of primary EBV infection.
Observation:
- Older patients with infectious mononucleosis frequently present with atypical symptoms.
- Key symptoms like lymphadenopathy, pharyngitis, splenomegaly, lymphocytosis, and atypical lymphocytes are often absent in this age group.
- Jaundice and hepatomegaly are observed more frequently in older individuals compared to adolescents.
Findings:
- The absence of classic IM symptoms in older adults can lead to diagnostic challenges.
- Hepatobiliary symptoms such as jaundice and hepatomegaly in older patients can mimic other serious conditions.
- Infectious mononucleosis in this demographic is often misdiagnosed as lymphoma, leukemia, biliary obstruction, or labeled as fever of unknown origin.
Implications:
- Increased awareness of atypical presentations of infectious mononucleosis in older adults is crucial for timely diagnosis.
- Distinguishing EBV infection from other conditions like malignancy or biliary disease is essential for appropriate patient management.
- This highlights the need for considering viral etiologies in older patients presenting with unexplained fever and hepatobiliary symptoms.
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