Boy with icteric tongue diagnosed with Epstein-Barr virus: Case Report

Canada: A recent case report published in the New England Journal of Medicine, describes the case of a 2-year-old boy who presented with a 4-day history of sore throat and dark urine. He was found to have jaundice with an icteric tongue, and the hemoglobin level was 6.1 g per deciliter. David Avelar Rodriguez and Julia Orkin from Hospital for Sick Children, Toronto, ON, Canada, made a diagnosis of cold agglutinin, EBV-induced acute hemolytic anemia.

The boy was brought to the hospital with a 4-day history of sore throat and a 3-day history of dark urine, abdominal pain, and pallor. On examination, he was found to have jaundice, with scleral and tongue icterus (Panel A) and dark urine (Panel B).

Laboratory studies showed a hemoglobin level of 6.1 g per deciliter (reference range, 11.0 to 14.5), a lactate dehydrogenase level of 6405 U per liter (reference range, 470 to 750), and an unconjugated bilirubin level of 115 μmol per liter (6.7 mg per deciliter; reference value, <12 μmol per liter [<0.7 mg per deciliter]); a direct antiglobulin test was positive, with cold agglutinins detected.