Introduction Infectious mononucleosis IM or mononucleosis sy

Introduction Infectious mononucleosis (IM) or mononucleosis syndrome is a common usually self-limited infection specifically caused by Epstein–Barr Erlotinib Hydrochloride Supplier (EBV). It occurs only in humans - frequently in childhood and adolescence-resulting in a life-long infection. The transmission of EBV is principally through exposure to infected saliva, hence, it is called “kissing disease”. It is routinely characterized by fever, sore throat, fatigue and cervical lymphadenopathy, but may present with severe manifestations and complications e.g. aplastic anemia, hepato and/or splenomegaly. Splenic rupture may occur and end fatally. Fortunately these complications are uncommon [1]. Neurological manifestations are infrequent in infectious mononucleosis and may include meningitis, encephalitis, peripheral neuropathy, but isolated hypoglossal nerve palsy (IHNP) is rarely reported [2]. A literature review revealed that in most cases, IHNP indicates the presence of an intra/extra-cranial space occupying lesion, vascular abnormality, head and neck injury/surgery, infectious process such as infectious mononucleosis, radiation, vertebral dislocation, autoimmune disease, traumatic orotracheal intubation or idiopathic. Clinically, patient may present with lingual dysarthria, atrophy and fasciculation of tongue musculature with deviation of the tongue to ipsilateral side on protrusion, due to unopposed action of the contra-side [3–5]. In this case report, we present a patient with left hypoglossal nerve palsy due to infectious mononucleosis, with an excellent outcome, after conservative treatment.
Case report Upon physical examination, there was bilateral cervical lymphadenopathy, temperature was 38.7 C, while blood pressure was 150/81. Examination of the oral cavity revealed congested throat and enlarged tonsils with exudates. Neurological assessment didn\'t reveal any acute issue except for the deviation of tongue towards the left side upon protrusion, but no atrophy nor fasciculation (Fig. 1). Patient responded positively to this regimen; where the fever came down to normal within three days with gradual remission of throat pain, difficult swallowing and cervical adenopathy. Within two weeks patient was able to protrude his tongue without deviation (Fig. 2). The patient was transferred to Infectious Disease Hospital for further care and follow up.
Discussion Infectious mononucleosis (IM) is a benign and self-limited disorder characterized by primary EB viral infection. Various neurological disorders, although uncommon, have been described in association with IM as meningitis, encephalitis and peripheral neuropathy. While any of the cranial nerves may be involved during EBV infection, an isolated hypoglossal nerve palsy is the least reported neurological complication and often present as a sign rather than symptom, although suspicious, is not pathognomonic of malignancy [6]. The relation between the time of onset of the clinical presentation of IM and the time of onset of the nerve palsy varies greatly, in our case it was 10 days. The possible explanation for this complication is presumably a local virus infection around the hypoglossal nerve nucleus [7]. The hypoglossal nerve is a motor nerve that innervates tongue musculature controlling its voluntary movements, when injured rarely causes much inconvenience; indeed, this nerve is often used in transplantation surgery to reanimate a paralyzed face [8]. Imaging studies, including CT scan and MRI, are mandatory in the diagnostic approach to find/rule out any causative pathology e.g. tumor [9]. In our case imaging data were unremarkable, as the nerve dysfunction was secondary to viral infection, and not induced by a lesion. Treatment of hypoglossal nerve palsy depends upon the cause. The prognosis of a complete recovery is excellent, although recovery may be prolonged [10]. Our case have been treated-as it was secondary to IM - satisfactorily with supportive treatment together with intra-venous antibiotics and corticosteroids.