Differential Diagnosis for Facial Swelling after Mononucleosis
Single Most Likely Diagnosis
- Infectious Mononucleosis (IM) Complication: Given the recent history of mononucleosis, the facial swelling, fatigue, and mouth sores could be a complication or a prolonged manifestation of the infection itself. Mononucleosis can cause various symptoms, including fever, sore throat, swollen lymph nodes, and fatigue, which can sometimes persist or evolve.
Other Likely Diagnoses
- Autoimmune Hemolytic Anemia (AIHA): This condition can be triggered by infections like mononucleosis. Symptoms might include fatigue (due to anemia), and potentially jaundice, though facial swelling is less common.
- Lupus or Other Autoimmune Disorders: Sometimes, infections can trigger autoimmune diseases. Lupus, for example, can cause a wide range of symptoms including facial rashes (often a butterfly-shaped rash), mouth sores, fatigue, and swelling in various parts of the body.
- Post-infectious Myocarditis or Pericarditis: Though less common, mononucleosis can lead to cardiac complications. Facial swelling could be indicative of fluid retention due to heart failure, and fatigue is a common symptom.
Do Not Miss Diagnoses
- Hodgkin Lymphoma: Mononucleosis can sometimes be a precursor or associated with the development of Hodgkin lymphoma. Symptoms can include persistent fatigue, swollen lymph nodes, and potentially facial swelling if there's significant lymphadenopathy.
- Thyroiditis: Subacute thyroiditis can be triggered by viral infections and might present with fatigue, facial swelling (due to thyroid gland inflammation), and potentially mouth sores, though the latter is less common.
- Sjögren's Syndrome: An autoimmune disorder that can be triggered by infections, characterized by dry eyes, dry mouth, and potentially swelling and fatigue.
Rare Diagnoses
- Kawasaki Disease: Though rare in adults, it can cause facial swelling, mouth sores, and fatigue, among other symptoms. It's more commonly seen in children but should be considered in the differential for unexplained symptoms.
- Angioedema: A rare condition that can cause sudden facial swelling, potentially triggered by infections or autoimmune conditions. It's less likely given the context but should be considered, especially if the swelling is acute and severe.
- Granulomatosis with Polyangiitis (GPA): A rare autoimmune disorder that can cause a wide range of symptoms including facial swelling, fatigue, and potentially mouth sores, though it's more commonly associated with respiratory and renal symptoms.
Given the patient's symptoms and recent history of mononucleosis, a thorough evaluation including blood tests (to check for anemia, signs of infection, or autoimmune markers), imaging studies (if necessary, to evaluate for lymphadenopathy or cardiac issues), and potentially a biopsy (if lymphoma is suspected) would be essential for a definitive diagnosis.