From the Research
Recurrent infectious mononucleosis should be managed with supportive care, including rest, hydration, and pain management with acetaminophen or ibuprofen, as there is no specific antiviral therapy approved for Epstein-Barr virus (EBV). The treatment approach should prioritize alleviating symptoms and preventing complications, given that true recurrences of mono are uncommon and may indicate underlying immune system dysfunction 1.
Key Considerations
- Patients should avoid contact sports and strenuous physical activity for at least 3-4 weeks after symptoms resolve to prevent splenic rupture, a rare but potentially fatal complication of infectious mononucleosis 2, 3, 4.
- Abstain from alcohol for at least 6 weeks to reduce liver strain, as infectious mononucleosis can cause liver inflammation.
- In severe cases with significant tonsillar swelling causing airway obstruction, a short course of corticosteroids like prednisone may be prescribed 5.
- Recurrent symptoms warrant further investigation to rule out other conditions that may mimic mono, such as chronic fatigue syndrome or other viral infections.
Management of Splenic Rupture
- Splenic rupture is a medical emergency that requires immediate attention; diagnosis can be confirmed through imaging studies like CT scans or ultrasound in stable patients, and peritoneal lavage in unstable patients 4.
- Treatment of choice for splenic rupture has traditionally been splenectomy, but non-operative management may be considered in hemodynamically stable patients with subcapsular hematoma without overt rupture of the capsule 3.
Experimental Approaches
- For cases of chronic active EBV infection, consultation with infectious disease specialists may lead to consideration of experimental approaches, including antiviral medications like valacyclovir, though evidence for their effectiveness is limited 1.
Given the potential for severe complications and the importance of supportive care in managing symptoms and preventing further issues, a comprehensive and cautious approach to recurrent infectious mononucleosis is essential, prioritizing patient education on symptom management, prevention of splenic rupture, and the potential need for further evaluation to rule out other conditions 2, 5, 3, 4.