![]() Lymphocyte-white blood cell count ratio: a quickly available screening tool to differentiate acute purulent tonsillitis from glandular fever. However, given that a falsely positive heterophile antibody tests is very uncommon, a positive result almost always indicates Epstein–Barr infection.Ĭhervenick PA. Furthermore, in many cases, the diagnosis of Epstein–Barr mononucleosis was not supported by a specific acute serology response but uniquely by a heterophile antibody test. The main limitations of this experience relate to the small number of included cases, who were examined by no more than three physicians, and to the failure to perform a periorbital ultrasound examination. In various cases of mononucleosis presenting with an upper lid swelling, orbital imaging revealed an enlarged lacrimal gland. On the other hand, in patients with the Hoagland sign, there is often drooping of the lateral aspect of the upper eyelid, a feature termed S-sign that is usually associated with an enlarged lacrimal gland. An infiltrate of lymphocytes in the periorbital tissue has been occasionally documented. Īt least two different mechanisms might underly the development of the Hoagland sign in mononucleosis. Taking a careful history and performing a thorough physical examination are essential to distinguish the Hoagland sign from the mentioned causes of eyelid swelling. ![]() Medication has also been implicated as a cause of eyelid swelling. However, the sign tended to be more common among females than among males (the tendency, however, failed to be statistically significant).Įyelid features resembling the Hoagland sign occur following trauma or insect sting, in infections of the palpebral region, in many allergic conditions and in diseases that cause fluid retention including among others some kidney diseases. In the present experience, cases with and without Hoagland sign did not significantly differ with respect to age and sex. Our results are supported by the seminal observations of Hoagland in 1952 : upper eyelid puffiness was found early in the course of illness in 2 out of 39 (3.6%) soldiers (likely predominantly males) with mononucleosis included in a retrospective case series and, subsequently in 19 out of 56 (34%) soldiers included in a prospective case series. The results of the present prospective experience point out that the Hoagland sign adds to the list of the common and characteristic features of mononucleosis and is likely more frequent than enlarged liver, enlarged spleen, jaundice or rash. Hence, early and rapid diagnosis is crucial. Furthermore, a leukemia or a lymphoma are occasionally suspected. The initial diagnosis of streptococcal pharyngitis (especially in throat carriers of this germ) or that of non-specific pharyngitis are often made. The presentation of mononucleosis may be heterogenous and, therefore, challenging. ![]() There is a need to expand awareness of this sign among physicians. The Hoagland sign is an easily identifiable clinical sign that is common and likely helpful early in the course of Epstein–Barr virus infectious mononucleosis. Patients with and without Hoagland sign did not significantly differ with respect to age and sex. The initial presentation included fever in 24, enlarged cervical lymph nodes in 23, pharyngitis in 21, a palpable liver in 7, a palpable spleen in 7, jaundice in 2, and a measles-like rash in 2 cases. Resultsĭuring the mentioned period, the diagnosis of mononucleosis was made in 26 (14 females and 12 males) subjects aged from 9.0 to 33 years. Methodsīetween 20, two of us evaluated all subjects with a positive acute Epstein–Barr virus serology for the typical signs of mononucleosis and for the possible existence of the Hoagland sign. This sign, referred to as Hoagland sign, is not or only marginally mentioned in reviews and textbooks. ![]() ![]() A painless bilateral swelling of the upper eyelid, sometimes with drooping of the lateral aspect, may also occur. The typical presentation of Epstein–Barr virus infectious mononucleosis includes fever, pharyngitis, measles-like rash, jaundice, and enlarged lymph nodes, liver, or spleen. ![]()
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