Which physical finds of acute tonsillitis suggest infectious mononucleosis?

Updated: Apr 06, 2020
  • Author: Udayan K Shah, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Tender cervical lymph nodes and neck stiffness are observed in acute tonsillitis. Examine skin and mucosa for signs of dehydration. Consider infectious mononucleosis due to EBV in an adolescent or younger child with acute tonsillitis, particularly when it is accompanied by tender cervical, axillary, and/or inguinal nodes; splenomegaly; severe lethargy and malaise; and low-grade fever. A gray membrane may cover tonsils that are inflamed from an EBV infection (see the image below). This membrane can be removed without bleeding. Palatal mucosal erosions and mucosal petechiae of the hard palate may also be observed.

Tonsillitis caused by Epstein-Barr infection (infe Tonsillitis caused by Epstein-Barr infection (infectious mononucleosis). The enlarged inflamed tonsils are covered with gray-white patches.

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