178 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
•Physical findings include fever, diffuse posterior lym-
phadenopathy, and tonsillar erythema and exudates. A
morbiliform rash may occur in patients prescribed
amoxicillin to treat a presumed strep throat, a finding
that can aid in diagnosis.
- Diagnostic studies include a lymphocytosis of >50%,
10% atypical lymphocytes on a peripheral smear, and
a positive heterophil antibody (monospot) test. Ten
percent of IM sufferers will have a negative monospot
(Bailey, 1994) in which case EBV serology should be
ordered. Approximately 25% of affected individuals
will also have GABHS pharyngitis (Bailey, 1994).
- Rest, hydration, saline gargles, and analgesics are all
that are generally needed. Antiviral treatment is not
indicated (Bailey, 1994).
•Severe tonsillar swelling responds well to prednisone
(40–60 mg qd for 5–10 days) (Bailey, 1994).- Splenic rupture occurs in 0.1–0.2% of all cases, and
almost always occurs between illness days 4 and 21 in
patients with splenomegaly. There is no correlation
between the severity of the illness and the susceptibil-
ity to splenic rupture. Left upper quadrant pain that
radiates to the left shoulder (Kehr’s sign) suggests
splenic rupture and demands immediate medical
attention (McDonald, 1997). Splenic rupture can
occur in the absence of significant physical exertion,
trauma, or strain and may be the presenting clinical
feature (Maki and Reich, 1982). - The guidelines in Fig. 31-2 will help guide return to
play decisions (Maki and Reich, 1982).
FIG. 31-2 Algorithm for return to play guidelines for athletes with infectious mononucleosis.