Infectious Mononucleosis and Porphyria

LIVER involvement in infectious mononucleosis is a well-recognised entity usually causing "hepatitis" or a hepato-cellular dysfunction. have reported a focal infiltration of mononuclear cells with reticulocyte proliferation and necrosis, and in fact one series of fifteen cases (Cohn and Lidman) all showed impairment of the liver as judged by abnormal biochemistry. Sherlock (1958) states that the changes indicate hyperplasia of the reticulo-endothelial system rather than hepato-cellular disturbance. She states that portal zone fibrosis is not a sequel and that cirrhosis is not a complication of infectious mononucleosis. It is also well recognised that porphyrinuria may be a manifestation of various types of liver dysfunction. Porphyrinuria associated with glandular fever does not, however, appear to have been described. Two cases are reported here in detail showing such an association and the significance is discussed. One of these patients died from liver failure as a sequel to infectious mononucleosis. An 18-year-old male, employed as a laboratory assistant, was admitted to a general medical ward in April, 1960, with a pyrexia of unknown origin. This had failed to respond to novobiocin and erythromycin which had been prescribed by his family doctor. He gave a history of intermittent attacks of dull pain in the right iliac fossa for approximately one year, but this had been present daily for five days prior to admission, accompanied by nausea, vomiting, anorexia, headache, and urinary frequency without dysuria. There was also a history of postural dizziness with one vaso-vagal attack a few days before admission. Examination revealed a well-built, hirsute, young male with signs of an acute toxic process, his temperature being 1030 F. A sinus tachycardia was present with pulse of 132/min. and blood pressure 160/95. Tender lymph nodes were present in both axilliae and later in the posterior cervical chain. The liver was palpable four finger-breadths below the right costal margin and the spleen was just palpable. Blood Count. Hxmoglobin= 14.6 G. per cent. (100 per cent.). White cell count=3,000 per c.mm.