Introduction
Infectious mononucleosis (IM) is a relatively common presentation to the Ear, Nose and Throat (ENT) department, with patients being admitted for symptomatic relief and hydration. These are generally young patients without medical comorbidities. The Epstein-Barr virus (EBV) is the most common cause of IM, with the remainder due to other viruses including cytomegalovirus (CMV), toxoplasmosis, and HIV.1
In patients with clinically suspected IM and atypical lymphocytosis, the diagnosis is generally confirmed with the monospot test. However, there is a false negative rate in up to 25% of adults in the first week of symptoms.2
There is abnormality in liver function tests (LFT) in a large proportion of patients presenting with IM but this is usually self-limiting.2 Patient admitted to hospital generally would have standard LFTs as part of initial work up for IM. The utility of this is unclear, however, it may support diagnosis in the first week of illness if the monospot test was falsely negative. In addition, in settings where there is no available screening or definitive tests for IM, deranged LFTs may support clinical diagnosis taken in conjunction with clinical symptoms.
Practice varies with regards to follow-up in patients with IM and abnormal LFTs. Although a self-limiting finding, an initially abnormal LFTs generally start a cascade for further tests until normal. Anecdotally, general practitioners are often asked to repeat LFTs at varying intervals following discharge from hospital to ensure resolution. There are no guidelines to inform this practice. In addition, some centres routinely do abdominal ultrasound to evaluate the liver and spleen in patients with IM and abnormal LFTs; the need for this practice is unclear.
This systematic review aims to evaluate evidence base on LFTs assessment and ultrasound abdomen in IM. Specifically, we sought to determine the proportion of patients with abnormal LFTs, time to resolution of abnormal LFTs from clinical presentation, findings on abdominal ultrasound, and occurrence of decompensated liver disease.