During the spring thoughts can turn to proms and teenagers kissing. The incidence of teenagers contracting mononucleosis, also known as mono or "the kissing disease" may also come to mind. However, recently I had a slightly older patient come in with a surprising benign illness. The 40-year-old woman came to see me for a check-up and she was feeling tired but was generally in good spirits. I happened to notice that her neck looked a little swollen so I decided to feel it to see if perhaps her thyroid was causing her neck to swell. Instead I found that her tonsils and all the lymph nodes in her cervical chain (lymph nodes in her neck) where swollen. I asked her a few lifestyle questions and found out that she has been feeling tired for several weeks – so tired that she had to take naps during the afternoon to make it to the end of the day. She also had a scratchy throat from time to time in the last month. After a brief physical exam and a rapid strep test for her throat, and based on her symptoms I thought she might have mononucleosis. I decided to request blood work to confirm this including a complete blood count, Epstein-Barr virus, Lyme disease and ANA titers. Ordering lab work is always a good objective measure that confirms clinical symptoms and rules out certain diseases as well.
When I told her that one of the diagnoses I was trying to confirm was mono, the woman could not believe she could be diagnosed with "the kissing disease”. I asked if she had mono as a teenager and she couldn’t remember ever having it. I told her that the Epstein-Barr virus (EBV) usually causes mono and it is generally transmitted through mucus or saliva from the nose, throat and sometimes tears. It can be transmitted through kissing or sharing drinking glasses or eating utensils. The immune system can usually clear the illness in three to four weeks. I also shared with her that if she did have mono as a young person it was possible that the stress she had been under had weakened her immune system so it was flaring up again.