A 16-year-old male presents complaining of fever, fatigue, and sore throat for the previous 2 days. His temperature is 102.1°C, blood pressure is 120/80, and heart rate is 98. On exam, you notice mild tonsillar erythema and significant exudates. He also has diffuse lymphadenopathy and a prominent spleen. A complete blood cell count is within the normal range but shows a lymphocytosis with atypical lymphocytes. What is the proper treatment?
Antipyretics and avoidance of contact sports for 4 weeks
+Blood cultures, broad-spectrum antibiotics, and admission
+This presentation is suggestive of infectious mononucleosis caused by EBV. Treatment is usually supportive and rarely requires admission. Patients may develop splenomegaly, and should be advised to avoid contact sports for at least 4 weeks to avoid splenic rupture. Acyclovir is active against EBV, but is only effective against oral hairy leukoplakia in HIV. Amoxicillin can be used for streptococcal pharyngitis, but when mistakenly used for EBV will cause a diffuse morbilliform rash. The patient does not have signs of sepsis, is not at risk for endocarditis, and has a presentation classic for EBV and does not warrant hospitalization. Dexamethasone is often utilized in streptococcal pharyngitis, but increased complications are noted in the setting of EBV. It should be avoided unless the patient has airway compromise.