Atypical transmission of Epstein-Barr virus to a medical practitioner—a case report

We present a case of a 26-year-old medical practitioner who was diagnosed with Epstein-Barr virus, pre-COVID-19, following exposure to respiratory droplets from an infected patient. The medical practitioner presented to his general practitioner with a 5-day history of bilateral upper-palpebral swelling (Hoagland’s Sign) and coryzal symptoms and was initially diagnosed with allergic rhinitis. The diagnosis was revised 2 weeks later, following the development of classical symptoms and serological evidence of Epstein-Barr virus infection. The Epstein-Barr virus specific antibody should be measured if suspicion for infectious mononucleosis is high with a negative monospot test. These specific antibody tests are superior in ruling out Epstein-Barr virus infection when compared to the heterophile antibody test for a negative outcome. There is a dearth of literature regarding Epstein-Barr virus transmission via respiratory droplets and our case appears to be the first reported incident of Epstein-Barr virus transmission in an immunocompetent healthcare worker after exposure to respiratory droplets from a patient’s sternutation. As such, we strongly advocate the use of masks and practising appropriate hand hygiene in all patients suspected or confirmed to have an acute Epstein-Barr virus infection and also seek to highlight the atypical nature of symptom manifestations and transmission seen in Epstein-Barr virus infections.