Upper airway obstruction in infectious mononucleosis

Area of Science:

• Otolaryngology
• Pediatric Infectious Diseases
• Critical Care Medicine

Background:

• Infectious mononucleosis (IM) is typically a benign viral illness.
• Rarely, IM can lead to severe upper airway obstruction.
• This obstruction is primarily due to pharyngeal lymphoid hyperplasia and edema.

Observation:

• A case of a child with IM presenting with hypersomnolence, sleep apnea, and stridor.
• Retrospective analysis of 72 cases of respiratory complications in IM.
• Guidelines for airway management in IM-related respiratory compromise were developed.

Findings:

• Mild airway obstruction with fever, odynophagia, and malaise treated with parenteral corticosteroids.
• Severe airway occlusion managed with immediate tonsillectomy.
• Tracheotomy reserved for progressive alveolar hypoventilation, hypercarbia, atelectasis, and bulbar paralysis.

Implications:

• Tonsillectomy is effective in resolving airway obstruction and improving swallowing in IM patients.
• Early recognition and appropriate airway management are crucial for preventing severe outcomes.
• This study provides a framework for managing respiratory complications of infectious mononucleosis.