Severe Thrombocytopenia in a Case of Epstein-Barr Virus-Induced Infectious Mononucleosis

Epstein-Barr virus (EBV) infections have variable presentations ranging from asymptomatic to the triad of fever, pharyngitis, and adenopathy in infectious mononucleosis. Although haematological abnormalities are commonly seen in EBV infections, severe EBV-associated thrombocytopenia is a rare presentation, complicating clinical diagnosis and requiring appropriate management. Here we describe a case of a 14-year-old female with severe thrombocytopenia (platelet count of 5 x10⁹/L) and spontaneous haemorrhage, accompanied by periorbital oedema, an uncommon symptom in EBV-associated infectious mononucleosis. She was treated with intravenous immunoglobulins and a four-day course of methylprednisolone. Treatment resulted in progressive platelet count recovery, and the patient was discharged seven days post-admission with a platelet count of 143 x10⁹/L. The case highlights the need to consider EBV infection as a differential diagnosis in patients presenting with acute severe thrombocytopenia.