A 16-year old boy presented with fever and a diffuse maculopapular rash. Examination revealed generalised cervical lymphadenopathy and hepatosplenomegaly. After intake of Ampicillin (prescribed by a local practitioner), the rash worsened. The most likely diagnosis is:
Infectious Mononucleosis Diagnosis
The patient presents with symptoms highly suggestive of Infectious Mononucleosis (Mono): fever, generalized cervical lymphadenopathy, and hepatosplenomegaly. These are common signs in adolescents affected by Epstein-Barr Virus (EBV).
Rash and Ampicillin Reaction
A key diagnostic clue is the worsening of the maculopapular rash after Ampicillin administration. Patients with Infectious Mononucleosis frequently develop a significant rash (often morbilliform) when given Ampicillin or Amoxicillin. This specific reaction is a strong indicator against simple drug allergies and points towards an underlying viral illness like Mono.
Differential Diagnosis Evaluation
- Dengue fever: While it causes fever and rash, the characteristic lymphadenopathy and hepatosplenomegaly are less prominent, and the Ampicillin reaction is not typical.
- Measles: Measles rash typically starts on the face and spreads downwards, often accompanied by cough and coryza, which are not mentioned here. The Ampicillin reaction is not a feature.
- Drug-rash: While possible, the pre-existing fever, lymphadenopathy, and hepatosplenomegaly make a primary drug reaction less likely than an underlying condition triggering a reaction to the drug. The Ampicillin reaction in the context of these symptoms strongly favors Mono.
- Infectious mononucleosis: This diagnosis aligns perfectly with the patient's age, fever, generalized lymphadenopathy, hepatosplenomegaly, and particularly the exacerbation of the rash upon receiving Ampicillin.
Therefore, Infectious Mononucleosis is the most likely diagnosis.
Important Questions from Viral Infections
- A 26-year old HIV infected male presents with odynophagia. Upper GI endoscopy demonstrates serpiginous ulcers in a normal surrounding mucosa in distal esophagus. The most likely diagnosis is:
- Cytomegalovirus esophagitis is particularly common in which group of patients?
- Which one of the following is a cause of early (0–4 weeks) infection in recipients of haematopoietic stem cell transplantation?
Which one of the following antiretroviral drugs is a Nucleoside reverse transcriptase inhibitor?
Which of the following combinations of the Human Papilloma Virus (HPV) serotypes are non-oncogenic?
