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Catastrophic ENT Complications of Pediatric Infectious Mononucleosis: Recent Experience at a Tertiary Pediatric
Lorenzo Gaini1,2, Anna Cozzi1, Gioia Piatti2
1Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, 20122 Milano, Italy.
Insights
Epstein-Barr virus (EBV) can cause severe pharyngotonsillitis in children, leading to life-threatening complications like airway obstruction or death. Prompt, multidisciplinary care is vital for managing these critical cases.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Critical Care Medicine
Background:
- Epstein-Barr virus (EBV) causes infectious mononucleosis (IM), commonly presenting as acute pharyngotonsillitis in children and adolescents.
- While typically benign, EBV-related pharyngotonsillitis can lead to severe, life-threatening complications.
Abstract:
Background: Epstein-Barr virus-related acute pharyngotonsillitis is common in children and adolescents and is generally managed successfully with positive outcomes by both ENT specialists and pediatricians. However, a variety of acute, life-threatening complications can occur, including upper airway obstruction and infectious or immune-mediated sequelae. Methods: This paper describes our recent experience with four pediatric patients presenting with severe ENT manifestations of infectious mononucleosis (IM) that led to life-threatening complications, all of whom were hospitalized and managed at our tertiary pediatric hospital between January 2022 and April 2025. Results: We report four cases (two boys and two girls) aged 5 to 16 years, hospitalized with complicated EBV-related pharyngotonsillitis. Presentations included respiratory distress (cases 1 and 2), hemophagocytic lymphohistiocytosis resulting in death (case 3), and a retropharyngeal abscess (case 4). Conclusions: The prognosis of IM in the pediatric population is generally favourable. However, acute, life-threatening complications may arise. In such cases, timely and coordinated multidisciplinary management involving ENT specialists, pediatricians, and anesthesiologists is crucial.
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