Infectious Mononucleosis with Upper Airway Obstruction: when tracheotomy and tonsillectomy can be helpful

Infectious mononucleosis is caused by Epstein-Barr virus, which infects more than 98% of the world's adult population. Approximately 90% of adults become antibody-positive before the age of 30. The ages of 15-24 years are the most likely time for the onset of symptoms. We report the case of a 13-year-old girl who came to our emergency department for bilateral erythematous-poltaceous tonsillitis complicated by dysphagia and dyspnea. She had a diagnosis of infectious mononucleosis. For some hours the young woman presented an inconsistency between a marked respiratory distress and the patency of her upper airways. Finally the clinical picture fell suddenly, requiring an emergency tracheotomy to ensure a patent airway. In the following days a diagnosis of a left parapharyngeal abscess was reached. A tonsillectomy with drainage of the parapharyngeal abscess was required. It is well known that infectious mononucleosis is typically a silent infection. We describe the case of a girl who risked losing her life due to aggressive infectious mononucleosis, and how we treated her. Such a complicated case has never been described in Literature.