Chronic infectious mononucleosis.

I N A GROUP of 2.06 patients who had infectious mononucleosis, had some symptoms which persisted for from three months to at least four years or longer. The syndrome included ease of fatigue, exhaustion, aching of the legs, weakness, depression, afternoon elevation of temperature (99.8 to 101 F.), moderate splenomegaly, low blood pressure, low blood sugar, often low specific gravity of the urine, and the presence of infectious mononucleosis cells in the blood. The 53 patients with the chronic symptoms included 2.2. males and 31 females. The ages ranged from 8 months to 6o years. There were younger than 19 years; 2.0-2.9 years, I2. 30-3 9 years, i 6; 40-49 years, i ; o-6o years, . The 8 month old child showed unusual diarrhea (“dysentery”) since birth, and examination of the blood showed infectious mononucleosis cells. The mother had acute infectious mononucleosis during pregnancy, one month before the birth of the child. Thirteen of the patients had the symptoms for from 3 tO 6 months; i for 7-12. months; 3 for 17-18 months; I I for one year; 8 from two and one-half to four years and 3 for at least six years. Some of the patients could give the exact date of the start of the symptoms, others within a month or so. Five gave the duration as “several months,” “several years,” “many years.” These patients had been sent in for study, with possible diagnoses of undulant fever, tuberculosis, Addison’s disease, Hodgkin’s disease, Rocky Mountain spotted fever, lymphosarcoma, hypothyroidism, menopausal syndrome, subacute bacterial endocarditis, neurasthenia and syphilis. All of the group showed infectious mononucleosis cells in the blood. The red blood cell and leukocyte counts and hemoglobin content were within normal limits. The infectious mononucleosis cells were of the mature type, with deeply basophilic cytoplasm, staining the peculiar blue characteristic of these cells. The nuclei showed the streaky chromatin, with fenestrations, and were often indented. Occasionally one or more of the large forms found in the acute type were noted. The cells constituted i to 7 per cent of the total leukocytes, rarely higher. These cells had been grouped with the lymphocytes or monocytes by uncritical technicians. In no case of the chronic group was the sheep cell (heterophile) agglutination titer above i 64. Five patients showed persistent “positive” Kahn tests, characterized as “general biologic reaction,” for one to six years. The presenting symptom was always weakness or ease of fatigue. The patients said that their legs were weak and ached. The fatigue was usually present on arising in the morning, but occasionally developed late in the morning or during the afternoon. Some had symptoms suggestive of hypoglycemia. Others had mental depression, nervousness, ease of perspiration and dizzy or giddy spells on arising. The fatigue appeared out of proportion to the physical data. The usual findings