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Updated: Jun 12, 2025
Separation of Immune Cell Subpopulations in Peripheral Blood Samples from Children with Infectious Mononucleosis
Published on: September 7, 2022
Gross Hematuria and Hemolytic Anemia in Infectious Mononucleosis
Chinmayi Sharma1, Navneet Venugopal2, Shivaiah Balachandra3
1AJ Institute of Medical Sciences and Research Center, Mangaluru, India.
Abstract:
Introduction. Infectious mononucleosis (IM), caused by the Epstein-Barr virus (EBV), typically presents with fever, tonsillopharyngitis, and lymphadenopathy while rare, renal, and hematological complications such as gross hematuria and hemolytic anemia can occur, particularly in children. Case Presentation. We describe a 15-year-old male with infectious mononucleosis presenting with abdominal pain, sore throat, and red-colored urine for three days. Laboratory findings revealed leukocytosis, elevated liver enzymes, and hemoglobinuria. Serological testing confirmed EBV infection. Despite intravascular hemolysis, the patient's anemia was mild, and he responded well to supportive care. Discussion. Gross hematuria and hemolytic anemia are uncommon in IM, with limited reports. Proposed mechanisms include viral-induced renal injury and autoimmune hemolysis. Differential diagnosis should consider other causes of hematuria, which can be differentiated through urine microscopy and serological tests. IM should be considered in patients with pharyngitis and hematuria, especially when other causes are excluded.
Insights
Infectious mononucleosis (IM), caused by Epstein-Barr virus (EBV), can rarely lead to kidney complications like gross hematuria. This case highlights a teen with IM presenting with hematuria and mild anemia, emphasizing EBV’s diverse clinical manifestations.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nephrology
Background:
- Infectious mononucleosis (IM), a common illness caused by Epstein-Barr virus (EBV), typically manifests with fever, pharyngitis, and lymphadenopathy.
- While generally benign, IM can present with rare renal and hematological complications, including gross hematuria and hemolytic anemia, particularly in pediatric cases.
Observation:
- A 15-year-old male with confirmed EBV infection presented with symptoms of IM, including abdominal pain, sore throat, and gross hematuria.
- Laboratory results indicated leukocytosis, elevated liver enzymes, and hemoglobinuria, consistent with intravascular hemolysis.
Findings:
- The patient experienced intravascular hemolysis and hemoglobinuria secondary to infectious mononucleosis.
- Despite hemolysis, the anemia was mild, and the patient's condition improved with supportive care, suggesting a self-limiting course for this rare complication.
Implications:
- This case underscores the importance of considering infectious mononucleosis in the differential diagnosis of pediatric patients presenting with pharyngitis and hematuria.
- Understanding the potential for rare renal complications like gross hematuria in IM is crucial for accurate diagnosis and management.
- Further investigation into the mechanisms of viral-induced renal injury and autoimmune hemolysis in EBV infections may improve clinical outcomes.
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