Can Infectious Mononucleosis Cause Nausea?
Yes, nausea can occur with infectious mononucleosis, though it is not among the classic triad of symptoms (fever, tonsillar pharyngitis, and lymphadenopathy) that define the disease. 1
Clinical Presentation of Infectious Mononucleosis
The characteristic features of infectious mononucleosis include:
- Classic triad: Fever, tonsillar pharyngitis, and lymphadenopathy 1
- Fatigue: Profound but typically resolves within three months 1
- Periorbital/palpebral edema: Occurs in approximately one-third of patients, typically bilateral 1
- Splenomegaly: Present in approximately 50% of cases 1
- Hepatomegaly: Occurs in approximately 10% of cases 1
- Skin rash: Erythematous and maculopapular, occurring in 10-45% of cases 1
Gastrointestinal Symptoms in Mononucleosis
While nausea is not prominently featured in the classic description of infectious mononucleosis, gastrointestinal involvement does occur:
- Hepatitis: A recognized manifestation that can develop during the disease course 2
- Hepatomegaly: Present in 10% of patients, which may be associated with nausea 1
- Night sweats and systemic symptoms: Significantly more common during the acute phase compared to other upper respiratory infections 3
Duration and Severity of Symptoms
The acute phase symptoms are significantly more severe and prolonged in mononucleosis compared to other viral upper respiratory infections:
- Acute phase: Fatigue, night sweats, and painful neck swelling are significantly more common and severe 3
- Post-acute symptoms: Getting tired easily, daytime sleepiness, and depression persist in many patients 3
- Prolonged illness: 11% of patients report symptoms lasting longer than 100 days, and 6% have symptoms persisting beyond one year 3
Clinical Context
When evaluating a patient with suspected mononucleosis who presents with nausea, consider:
- Hepatic involvement: Check for hepatomegaly and obtain liver function tests if nausea is prominent 1, 2
- Splenic enlargement: Assess for splenomegaly, which occurs in half of patients 1
- Alternative diagnoses: If heterophile antibody testing is negative, consider other causes of mononucleosis-like syndrome including cytomegalovirus (5-7% of cases), Toxoplasma gondii (<1%), and viral hepatitis 4
Important Caveats
- Age-related presentation: Primary EBV infection in children under 10 years is usually asymptomatic or shows nonspecific courses, making diagnosis more challenging 2
- False-negative heterophile tests: Can occur in children under 10 years and in early disease 5
- Severe complications: While rare, life-threatening complications including splenic rupture (0.1-0.5% of cases) require vigilance 1, 6