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KMID : 0390320200300010023
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Chungbuk Medical Journal
2020 Volume.30 No. 1 p.23 ~ p.29
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Cytomegalovirus mononucleosis with triple-positive immunoglobulin M antibodies in a 26-month-old child: A case report
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Imura Erika
Kang Su-Sie
Lee Joon-Kee
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Abstract
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Background: Fever is one of the most common causes of emergency department visits in children. A diagnosis of fever of unknown origin invariably causes much anxiety to both caregivers and physicians. Notably, a few viruses are known to cause prolonged fever, although the prognosis of the disease itself ranges from good to excellent in such cases.
Case presentation: A 26-month-old girl was admitted to the Department of Pediatrics with a 15-day history of fever. On physical examination, the child did not appear markedly ill and showed no prominent abnormalities except palatine tonsillar hypertrophy. Serological examination results indicated the possibility of cytomegalovirus (CMV), Epstein-Barr virus, and Mycoplasma pneumoniae infection. Subsequent work-up revealed that her fever was attributable to CMV infection. The patient was discharged after 4 weeks, following treatment for fever. Notably, she was afebrile for 3 days but
returned to the emergency department shortly thereafter, with fever up to 41.2oC. We observed a mild cough; however, owing to elevated serum aminotransferase levels on laboratory testing, we could not exclude CMV infection-induced complications. She was referred to another hospital where she was diagnosed with adenovirus infection and returned to the outpatient department without any evidence of illness.
Conclusions: Vigorous workup is essential in patients with fever that could be attributed to multiple pathogens. Physicians should objectively consider the possibility of a continued preceding disease vs. infection caused by a different pathogen that could show an identical clinical presentation.
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KEYWORD
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Cytomegalovirus, Serology, Viruses
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