Our Summary

Infectious mononucleosis (IM), often known as “mono,” is a common illness caused by the Epstein Barr virus (EBV). It usually causes fever, sore throat, and swollen lymph nodes. However, this research paper describes a unique case where a 25-year-old man showed signs of mono but was actually suffering from acute sinusitis, an infection or inflammation of the sinuses, caused by the same virus.

The man came to the emergency room with sinus pain, fever, and a greenish nasal discharge that had been present for three weeks. A computerized scan of his face showed extensive sinusitis and a polyp, which is an abnormal growth of tissue. He had surgery to drain the infection and remove the polyp.

Further lab tests showed the man had a high number of white blood cells called lymphocytes, which is a common sign of mono. He also tested positive for EBV, confirming an acute infection. Despite this, he was given broad-spectrum antibiotics, which are typically used to treat bacterial, not viral, infections. His symptoms improved significantly after 10 days.

The unique aspect of this case is that EBV has not previously been reported as a cause of acute sinusitis. Some research has suggested a link between EBV and a type of cancer called extranodal NK/T cell lymphoma, but it’s unclear whether this patient, who had EBV sinusitis, would be at a higher risk for this cancer in the future.

In conclusion, this case suggests that doctors should consider the possibility of mono in patients who have a high number of lymphocytes and symptoms that don’t typically point to mono. Further research is needed to understand the relationship between EBV and sinusitis, as well as the potential cancer risk.

FAQs

  1. What are the typical symptoms of mono and how do they differ from this unique case?
  2. How was the sinusitis and nasal polyp treated in this case?
  3. What implications does the finding of EBV as a cause of acute sinusitis have on future diagnosis and treatment?

Doctor’s Tip

A helpful tip a doctor might give a patient about nasal polyp removal is to follow post-operative care instructions carefully to ensure proper healing and reduce the risk of complications. This may include avoiding strenuous activities, keeping the nasal passages moist with saline sprays, and taking prescribed medications as directed. It’s also important to attend follow-up appointments to monitor healing progress and address any concerns promptly.

Suitable For

Patients who are typically recommended nasal polyp removal are those who have chronic sinusitis that does not respond to other treatments, have severe symptoms such as difficulty breathing or loss of smell, have recurrent sinus infections, or have nasal polyps that are causing other complications such as obstructing the nasal passages. In the case described above, the patient was recommended nasal polyp removal due to acute sinusitis caused by the Epstein Barr virus.

Timeline

Before nasal polyp removal:

  • Patient experiences symptoms such as sinus pain, fever, and nasal discharge for three weeks
  • Patient undergoes a computerized scan that reveals sinusitis and a polyp
  • Lab tests show high levels of lymphocytes and a positive EBV test, indicating acute sinusitis caused by EBV
  • Patient receives broad-spectrum antibiotics and undergoes surgery to drain the infection and remove the polyp

After nasal polyp removal:

  • Patient’s symptoms improve significantly after 10 days
  • Patient’s case highlights the unique relationship between EBV and acute sinusitis
  • Further research is needed to understand the potential long-term effects and cancer risk associated with EBV sinusitis.

What to Ask Your Doctor

Questions a patient should ask their doctor about nasal polyp removal:

  1. What is the reason for removing the nasal polyps?
  2. What are the potential risks and complications of the removal procedure?
  3. What is the success rate of the procedure in relieving symptoms?
  4. Will I need any follow-up appointments or additional treatments after the removal?
  5. How long is the recovery period after the procedure?
  6. Will there be any changes to my sense of smell or taste after the removal?
  7. Are there any lifestyle changes or precautions I should take after the procedure to prevent polyps from returning?
  8. Will I need to take any medications before or after the procedure?
  9. Are there any alternative treatments or therapies available for nasal polyps?
  10. What should I do if I experience any unusual symptoms or complications after the removal?

Reference

Authors: Khine S, Edupuganti S, Upadhyay M, Liroff K. Journal: Eur J Case Rep Intern Med. 2023 Sep 5;10(10):004039. doi: 10.12890/2023_004039. eCollection 2023. PMID: 37789985