A 17-year-old girl from southern China has had a sore throat and fever for 1 week. On physical examination, generalized lymphadenopathy is noted
A rapid strep test for streptococcal infection is negative and a CBC shows 20% atypical lymphocytes. A Monospot test for the presence of heterophile antibodies is positive. This illness is associated with eventual development of which of the following malignancies?
A. Kaposi's sarcoma
B. Cervical carcinoma
C. Follicular lymphoma
D. Human T cell lymphoma
E. Nasopharyngeal carcinoma
ANS: E. The clinical manifestations described are classic for infectious mononucleosis secondary to Epstein-Barr virus (EBV) infection. These include sore throat, fever, fatigue, and generalized lymphadenopathy. The differential diagnosis for sore throat includes streptococcal infection; however, the rapid strep test for streptococcal infection is negative in this patient. In addition, the peripheral blood smear of patients with mononucleosis often contains abundant numbers of large morphologically atypical lymphocytes. EBV infection is one of the etiologic factors associated with malignant tumors, including nasopharyngeal carcinoma in Chinese populations, Burkitt's lymphoma in equatorial African populations, and other B cell lymphomas in immunosuppressed populations.
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