Are corticosteroids safe in adolescent and adult patients with infectious mononucleosis? A retrospective cohort study.

BACKGROUND AND AIM: The use of systemic corticosteroids during Epstein-Barr virus (EBV)-induced infectious mononucleosis is a controversial but widespread practice. We aimed to investigate the frequency of complications in adolescents and adults with infectious mononucleosis in relation to the use of corticosteroids. METHODS: We reviewed the clinical records of 396 patients admitted to the hospital with infectious mononucleosis (52.0% male; median age, 19 years; range, 15-87 years), with a focus on both short-term (infectious and non-infectious) and long-term (hematological malignancies) complications in relation to corticosteroid use. RESULTS: A total of 155 (38.6%) patients received corticosteroids at some point during infectious mononucleosis. Corticosteroid use was significantly (P≤0.002) associated with sore throat, lymphadenopathy, leukocytosis, and with antibiotics use (mainly indicated after suspicion of tonsillar bacterial superinfection). Overall, 139/155 (89.7%) patients who were treated with corticosteroids also received antibiotics either before or during hospitalization, compared with 168/241 (69.7%) patients who did not. The frequency of short-term severe complications, either infectious (peritonsillar-parapharyngeal abscess or bacteremia) or non-infectious (splenic rupture, severe thrombocytopenia, myopericarditis, or lymphocytic meningitis) were similar in patients receiving and not receiving corticosteroids. After a median of 15 years of follow-up, only one Hodgkin's lymphoma was diagnosed, in a patient who was not treated with corticosteroids during infectious mononucleosis. CONCLUSIONS: The use of systemic corticosteroids during EBV-induced infectious mononucleosis is generally safe, at least with concomitant antibiotic therapy. However, this should not encourage the use of corticosteroids in this context, given that their efficacy has yet to be demonstrated.

Hematological Abnormalities Beyond Lymphocytosis During Infectious Mononucleosis: Epstein-Barr Virus-Induced Thrombocytopenia.

Background: Thrombocytopenia during Epstein-Barr virus mononucleosis is well-known; however, no recent series have investigated its frequency, associated factors, and evolution. The present study aimed to investigate platelet count characteristics in adult patients with infectious mononucleosis. Methods: We reviewed the clinical records of 400 patients admitted to the hospital with infectious mononucleosis (52.0% male; median age, 19 years [range, 15-87 years]), focusing on blood platelet counts, thrombocytopenia prevalence and outcomes. Results: Thrombocytopenia (platelet count ≤150 ×109/L) was present in 119 (29.7%) patients. Thirty-two (8.0%) patients showed platelet counts lower than 100 ×109/L. Thrombocytopenia was severe (platelets <50 ×109/L) in 6 (1.5%) patients. Thrombocytopenia was associated with a lower frequency of typical mononucleosis symptoms such as sore throat and lymphadenopathy, lower frequency of positive heterophil antibodies, higher serum bilirubin concentration and prothrombin time, lower blood leukocyte and lymphocyte count, lower concentration of serum immunoglobulin G and immunoglobulin A concentrations, and larger spleen size. Thrombocytopenia normalized quickly during follow-up. Only 2 cases required specific therapy. Platelet counts significantly increased during follow-up, even in cases without baseline thrombocytopenia. There were no significant hemorrhagic complications. Conclusions: Transient thrombocytopenia is common during infectious mononucleosis in adult patients. Patients with thrombocytopenia have distinct clinical and biological features; it is typically mild during infectious mononucleosis. Cases of severe thrombocytopenia are rare and were not associated with hemorrhagic complications in this series.

Jaundice in relation to immune activation during Epstein-Barr virus-induced infectious mononucleosis.

BACKGROUND: Liver involvement during infectious mononucleosis is common, but jaundice is considered rare. This study aimed to investigate serum bilirubin concentrations in patients with infectious mononucleosis and immune abnormalities associated with jaundice. METHODS: We report on an adult patient with monoclonal B lymphocytosis and IgM-lambda gammopathy who developed a severe icteric hepatitis during infectious mononucleosis. We then reviewed the clinical records of 389 patients admitted to the hospital with infectious mononucleosis between 1995 and 2018 (51.7% male patients; median age, 19 years; range, 15-87 years) with focus on liver abnormalities and associated factors. RESULTS: Fifty-nine patients (15.1%) had serum bilirubin concentrations between 1.5 and 3 mg/dL, and 47 patients (12.0%) had serum bilirubin >3 mg/dL. Patients with increased bilirubin concentrations had a distinct clinical presentation, with more frequent abdominal pain, nausea and vomiting, and less frequent sore throat than patients with normal bilirubin. Age and sex were not significantly different for the patients with increased and normal serum bilirubin concentrations. The patients with increased serum bilirubin concentrations showed higher levels of immune activation markers than the patients with normal bilirubin, including blood lymphocyte counts, serum IgM, and ß2-microglobulin concentrations. Heterophile antibody-positive patients (88.6%) showed similar bilirubin concentrations but higher aspartate aminotransferase and alkaline phosphatase levels than their heterophile-negative counterparts. Serum bilirubin elevations normalized quickly during follow-up. CONCLUSIONS: Transient hyperbilirubinemia is common during severe (in-hospital) infectious mononucleosis in adult patients. Patients with hyperbilirubinemia have less frequent pharyngitis symptoms and more frequent abdominal symptoms. Hyperbilirubinemia during infectious mononucleosis is associated with immune activation markers.

Transient hypertriglyceridemia: a common finding during Epstein-Barr virus-induced infectious mononucleosis.

BACKGROUND: Hypertriglyceridemia can occur in lymphoproliferative disorders. Infectious mononucleosis is a self-limiting, benign lymphoproliferative disorder. This study aimed to investigate the serum triglyceride concentrations and their change over time in patients with infectious mononucleosis. METHODS: We evaluated an adult patient with severe hypertriglyceridemia (>1000 mg/dL) during infectious mononucleosis and reviewed the records of 360 patients admitted to our hospital because of infectious mononucleosis (median age, 19 years; range, 15-87 years; 51.4% male). We compared the serum triglyceride concentrations with those of a control sample from the general population (n=75). A second triglyceride measurement, obtained during convalescence (median of 30 days after the initial determination), was available for 160 patients. RESULTS: The triglyceride concentrations in the acute phase (median: 156 mg/dL) were significantly higher than those of the controls (median, 76 mg/dL; P<0.001). A total of 194 (53.9%) patients presented with hypertriglyceridemia (>150 mg/dL), which was more common in the patients older than 30 years than in the younger patients (78.6% vs. 50.6%; P<0.001). A significant correlation (P<0.005) was observed between the triglyceride levels and white blood cell counts, total cholesterol levels, and liver damage markers. The triglyceride concentrations decreased during convalescence (P<0.001) and were lower than the initial measurement in 83.7% of the cases. Conversely, the total cholesterol concentrations during the acute phase were lower than those of the controls and increased during convalescence (P<0.001). CONCLUSIONS: Patients with severe infectious mononucleosis frequently show mild, transient hypertriglyceridemia. Further studies are needed to elucidate the mechanisms underlying this finding.

Trombocitosis extrema durante una pielonefritis aguda. Consecuencia colateral de la pandemia por Coronavirus (COVID-19) / Extreme thrombocytosis during acute pyelonephritis. Collateral consequence of the Coronavirus (COVID-19) pandemic

A young woman with extreme (>1,000x109/L) thrombocytosis during Escherichia coli pyelonephritis is presented. Diagnosis of pyelonephritis was delayed after several teleconsultations for atypical symptoms during the COVID-19 pandemic. Virtual clinic models can lead to protracted courses and bizarre manifestations of infectious disease. (AU)

Hemorragia digestiva alta por ingestión de un comprimido en blíster / Gastric hemorrhage after ingestion of a blister-wrapped tablet

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Acute focal bacterial nephritis in a cohort of hospitalized adult patients with acute pyelonephritis. Assessment of risk factors and a predictive model.

BACKGROUND: Acute focal bacterial nephritis (AFBN) is a complicated form of acute pyelonephritis (APN) characterized by single or multiple areas of localised infection in the kidney without liquefaction or abscess. Studies investigating AFBN in adults are scarce. AIM: The present study was aimed at evaluating the prevalence, associated factors, and presence of atypical clinical and radiological manifestations in adult AFBN patients. Also, we developed a clinical prediction model to evaluate the probability of AFBN in patients with APN. METHODS: The clinical records of 377 patients (mean age 54years, 74.0% females) admitted to a hospital over a 5-year period with APN were reviewed. RESULTS: A total of 57 cases of AFBN were radiologically identified (prevalence, 15.1%). Patients with AFBN were younger and displayed atypical manifestations more frequently than patients without AFBN; these included both clinical and radiological (pleural effusion, gallbladder wall thickening, fluid around the gallbladder, perirenal fluid, and ascites) manifestations. Patients with AFBN showed lower systolic blood pressure and needed more days of therapy to become afebrile, longer total duration of antibiotic therapy, and longer hospital stay than patients without AFBN. Contraceptive use was more frequent in patients with AFBN. A model based on five clinical variables showed good discrimination performance for the diagnosis of AFBN (Area under the curve, 0.77 (95% CI, 0.69-0.89)). CONCLUSIONS: Patients with AFBN frequently present with atypical clinical and radiological manifestations. Clinical presentation by means of a predictive model may predict the presence of AFBN. Patients with AFBN need more intensive therapy, which is followed by a favourable outcome.

Peritonitis bacteriana espontánea por Sphingomonas paucimobilis en un paciente cirrótico / Spontaneous bacterial peritonitis due to Sphingomonas paucimobilis in a cirrhotic patient

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Enfermedad de Paget. Deformidad en «cayado de pastor» / Paget's disease. «Shepherd's crook» deformity

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