title: An adolescent girl with Crohn's disease, fever, and sore throat.
abstract: An adolescent female with a past medical history significant for Crohn's disease presented with fevers, tonsillitis without exudate, and tender posterior cervical lymphadenopathy. Laboratory results showed transaminitis, leukocytosis with a left shift, and atypical lymphocytes on a blood smear. The patient did not respond to supportive care or dexamethasone, necessitating a tonsillectomy and adenoidectomy. Although her presentation was consistent with infectious mononucleosis, diagnosis was not confirmed until Epstein-Barr virus (EBV) polymerase chain reaction (PCR) from tonsillar tissue was positive. False-negative results on the heterophile antibody test are common in pediatric populations and the detection of EBV antibodies is further complicated in immunocompromised patients. Studies indicate PCR is a more sensitive test, although there is no consensus regarding ideal material to use or quantitative levels necessitating intervention.
authors.forename: Richa
authors.initials: R
authors.lastname: Garg
authors.forename: Colleen
authors.initials: C
authors.lastname: Rusciolelli
authors.forename: Mark E
authors.initials: ME
authors.lastname: Gerber
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005334:Fever; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D007244:Infectious Mononucleosis / Q000175:diagnosis*; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D010612:Pharyngitis; D016133:Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed; D014068:Tonsillectomy; D014069:Tonsillitis / Q000150:complications / Q000209:etiology* / Q000601:surgery
chemical_list: D008727:Methotrexate