Recurrent Infectious Mononucleosis

More than one attack of infectious mononucleosis, with prolonged periods of good health in between, appears to be very uncommon. Bernstein (1940), in his review of the disease, lists five instances of recurrence, in only one of which, that of De Vries (1938), was the diagnosis confirmed by the Paul-Bunnell reaction. Here the patient had initially an icteric type of illness which was followed a year after recovery by an episode of glandular enlargement with fever. The Paul-Bunnell reaction was strongly positive in the second illness. As that test was not done on the first occasion, it seems that the possibility of this case being infective hepatitis is not entirely excluded. Search of the more recent literature has revealed only one other probable case with repeated attacks (Rugg-Gunn, 1954). This patient ran a fever and had enlarged glands at the age of 6 years, but was not then investigated haematologically. When 14 he showed enlargement of the glands of the neck, had his blood examined, and was labelled " glandular fever." When he was 20 he complained of malaise, headaches, and lumps in the neck. Lymph nodes were palpably enlarged in the cervical, inguinal, and epitrochlear regions, the last being also tender. His white-cell count gave a total of 8,400 per c.mm. (28% neutrophils, 72% lymphocytes). The Paul-Bunnell reaction on this occasion was positive to a titre of 1 in 112 on admission. The following case report is -of a young man who has had three attacks of infectious mononucleosis in seven years and in whom the diagnoses have been supported by laboratory evidence.