Infectious Mononucleosis with Hepatitis

[Joalexa]

My 17 year old daughter was diagnosed with EBV (infectious mononucleosis).  Her monospot was negative but the hospital did an expensive and sensitive blood test that came up positive for Epstein Barr.  She has low WBC and platelets, normal RBC, elevated liver enzymes with jaundice.  We were told this is common with a viral infection like mono.  Ultrasound showed mildly swollen spleen and liver.   She has been running a fever of 101.4 every night and is exhausted.  Is hepatitis common with mono?  She has had these symptoms for almost 2 weeks.  I'm worried about her.  She looks sick and sometimes has nauseau and vomiting, although the doctor gave her zofran.  The doctor repeated blood work today to keep a close eye on her.  Thanks for any help!

[mkh9]

Glad to help. You still have your sense of humor!  LOL. 13,000 WBC is high but not too bad. Under 10,000 is normal so that is typical for this. Glad the liver enzymes are going down (not up) and the Xray is normal. Sounds like she is on the mend. The fever is a bugger.
have a good night.
mkh9

[Joalexa]

Thank you again!  You are so kind to offer comfort to a lady needing lots of wine :). The chest X-ray was negative, the liver enzymes are coming down, her WBC was 13 which is high but probably not too surprising considering her infection.  Doctor will repeat tests in a week to watch WBC and liver of course. I am hoping the fever breaks soon!  Thank you again :)

[mkh9]

Glad you saw the doctor. I had a feeling the bilirubin would be higher since the color of urine was yellow. But the liver enzymes are way high so that is good. I'm glad the Tylenol is controlling the fever. That is about all that can do other than bed rest. I hope that her immune system with fight it off soon. Yes I knew the fever was because of mono but I was worried about it being so high. As long as you keep it down but that the one Tylenol isn't raising the liver enzymes too much then things will be ok. Don't worry about the weight loss she will gain it back quickly. When I was getting sick due to a lot  undiagnosed migraines in my 20's I drank milkshakes to my weight up. That along with my regular food. But her appetite isn't good. But when she starts to get her appetite back she will be able to eat what ever she wants and the weight will come back fast. I feel for you. I know you are stressed. But I hope you are getting some support and know that you are on the right track.
take care of your self too!
mkh9

[Joalexa]

The doctor said EXACTLY what you said...she has a complicated case of mono that will take a bit longer to resolve.  So the doctor sent her off for yet another set of blood tests.  She was NOT happy :(  Her bilirubin was 2.0 and her other liver enzymes continue to be "slightly elevated" so we will wait until this next set of tests come in.  He also ordered a chest x-ray to rule out pneumonia although her lungs sounded clear.  At this point, he thinks she has a bad case of mono (she lost 3 pounds in 2 weeks too).  So he will compare these tests to the tests taken 3 days ago and see if she is stable, improving or worse.  The fevers he attributes to mono, it's just so strange that her temp during the day is like 97.7 but jumps to 102 at night.  One tylenol (325 mg) seems to do the trick, so its not like she is taking tylenol all the time.  Yes, I am ready for that Valium Vacation!  She knows the importance of keeping hydrated.  And she takes a few bites of her meals and is full.  Yet she polished off a bowl of fruit loops during the night.  Thank you for your positive comments...they really make me feel a little better.  I know this will resolve, but can it hurry up already!  

[mkh9]

You poor thing and I feel sorry for your daughter. Yes you do need valium. It must be very stressful for you! Can she drink more water? The dark urine is mostly from the liver. But I'm worried about how high her fever is. Be sure to tell the doctor how high the fever got. I 'm sure you will but that is important. Yes the symptoms of mono do last a long time. But the high fever is worrysome. You need to keep it down without damaging the liver. It is a tough balance. Just remember it will pass soon.  It is a  little more complicated due to the liver involvement. I am interested to know what the doctor says. The fever is there to fight off the virus but still you don't want brain damage. What fine balance the body has.
big hug,
mkh9

[Joalexa]

I need a vacation to Valium Island!  She ran 102.9 fever at 3 am.  Urine was dark after being clear today (bilirubin from liver involvement) and itching (liver too I think).  I have to stay off the Internet.  She only takes one 325 mg tylenol every 24 hours for the night fever.  Doctor said liver enzymes "slightly elevated".  He said fevers fluctuate with mono.  My nerves!  We will see the doctor today to check out her cough and go over test results.  It's amazing how long the fever can last with mono!

[mkh9]

Yes it is bad to have a  fever that high but mono does cause a fever for a while. I'm glad it doesn't stay up during the day. Did the doctor give her anything to get the fever down? You can't give Tylenol I don't think, because of the liver. It will cause problems for the liver. Fevers do go up at night normally when you are ill. If it has been two weeks it should start to go down soon. If the doctor doesn't know about the fever you may want to call to see if they are concerned about it being 101. That is pretty high. Keep cool wash rags on her head at night if you can or a cool pack, not ice though.
mkh9

[Joalexa]

Thank you again for the positive thoughts.  She still feels the same.  The night fevers are what bothers me at this point.  Every night around 1:30 am she wakes feverish (101) and nauseous.  No fever that I know of during the day.  Is this typical with this virus?  I would feel so much better (and so would she) if the fever would just go away.  It's been almost 2 weeks :(  Does it have something to do with the body at rest (sleep) that causes the fever?  Again, thanks for any information!

[mkh9]

Good to hear that the blood work is looking better. She will improve soon.
mkh9

[Joalexa]

Thank you so much for taking the time to reply.  She had blood drawn yesterday and her blood counts are now in the normal range. Her WBC went from 2.5 to 11.8 in one week.  Her liver enzymes are still slightly elevated and she is still feeling poorly.  Her doctor assured us that he consulted with a gastro enterologist who told him that liver involvement does occur with EBV.  She still has the fevers at night.  Her doctor will follow her closely (we see him on Thursday) and said he will repeat blood work until her liver numbers are normal.  I really appreciate you taking the time to explain this to me.  Take care.

[mkh9]

Hi and so sorry your daughter is so ill. Yes it is more rare but you can get liver problems  and jaundice from Mononucleosis. You can also get a strep throat infection, low platelet count, skin rash, and enlarged spleen. The enlarged spleen is more common than enlarged liver. She has to be careful as long as the spleen is enlarged to not do too much activity if she goes back to normal until the spleen and liver go back to normal size. The usual symptoms are Sore throat, fatigue, swollen lymph nodes, high fever, and headache. The symptoms usually last 2-3 weeks but can last up to 6 weeks. So, all the symptoms are related to the Mono or the causative agent Epstein Barr virus. She will be contagious (infectious) the whole time she has this. But, up to about 90% of adults have been exposed.  I hope she feels better soon. FYI, all adults shed EBV virus off and on throughout their life and will usually not have symptoms. You can't do much about this as they won't have symptoms. That is why most people have antibodies to it.
Take care,