Author Affiliation: Divisions of General Internal Medicine and Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Md.
Grand Rounds at The Johns Hopkins Hospital Section
Editors: David B. Hellmann, MD, D. William Schlott, MD, Stephen
D. Sisson, MD, The Johns Hopkins Hospital, Baltimore, Md; Edie Stern,
managing editor, The Johns Hopkins Hospital; David S. Cooper, MD,
Contributing Editor, JAMA.
A previously healthy 42-year-old man developed temperatures to
38.8°C, muscle and joint aches, fatigue, and loss of appetite. Within
several days, he also had diarrhea and emesis. On the fourth day of his
illness, he saw his physician, who made a diagnosis of gastroenteritis.
When the fever and fatigue had continued for 2 weeks, the patient went
to an urgent care center. By this time, his enteric symptoms had
ceased. He had no complaints of headache, sore throat, or rash. He was
described as looking tired. He had a temperature of 38.2°C, blood
pressure of 126/70 mm Hg, pulse of 94/min, and respirations of 18/min.
He had no icterus. His oropharynx showed no injection or exudate. The
examining physician did not report lymphadenopathy and judged his liver
and spleen to be of normal size. There were no other notable findings.
The patient again left with a diagnosis of gastroenteritis.
Auwaerter PG. Infectious Mononucleosis in Middle Age. JAMA. 1999;281(5):454–459. doi:10.1001/jama.281.5.454