Case Study Three:
A 14-year-old boy came to the physician's office with a sore throat that progressively worsened over a three-day period. His posterior pharynx was swollen, shiny and erythematous. The boy complained of pain on swallowing. His temperature was 98.5°F.
A rapid direct streptococcal antigen test was positive. However, his symptoms did not subside over the next two days while on antibiotic therapy. Anorexia and nausea were persistent and compounded by a frontal headache. Cervical lymph nodes became noticeably enlarged.
A complete blood count (CBC) was ordered.
The results of the CBC were:
WBC 11.9 x 109/L ( Reference interval= 3.8 - 9.8 x 109/L) with:
- 17% segmented neutrophils
- 5% band neutrophils
- 72% lymphocytes
- 6% monocytes
- All red cell findings were normal.
The automated differential flagged for atypical cells, presumptively atypical lymphocytes. A peripheral blood smear was prepared. The image on the right is a representative field from the Wright-Giemsa stained smear (1000X magnification).
A rapid qualitative test for infectious mononucleosis was positive.
This is a case of a concurrent group-A streptococcal infection along with infectious mononucleosis. Symptoms subsided in three weeks following completion of the antibiotic therapy.