Case report about Hoagland's sign: a useful clinical sign for the early diagnosis of infectious mononucleosis. Pediatric report

Abstract

Case presentation. Infectious mononucleosis, typically presents with the classic triad of fever, tonsillitis, and cervical lymphadenopathy. However, early atypical manifestations such as bilateral eyelid edema, known as Hoagland’s sign, are often underrecognized, particularly in pediatric and young adult patients. Failure to identify this sign may result in misdiagnosis, delayed testing, and unnecessary antibiotic use. Early recognition of Hoagland’s sign can therefore facilitate prompt diagnosis and appropriate management. We report the case of a seven-year-old girl who presented with acute bilateral, non-inflammatory eyelid edema accompanied by fever, tonsillitis, and cervical lymphadenopathy. The early identification of periorbital edema as Hoagland’s sign raised suspicion for infectious mononucleosis and enabled a timely diagnosis. Laboratory assessment, revealed 15% reactive atypical lymphocytes on peripheral blood smear, a characteristic hematological finding. Cervical ultrasound demonstrated multiple enlarged lymph nodes in both the anterior and posterior

cervical regions. Serological testing confirmed infectious mononucleosis through the detection of heterophile antibodies during the second week of illness. Treatment. Was symptomatic, consisting of nonsteroidal anti-inflammatory drugs without the need for corticosteroids, antivirals, or antibiotics. Outcome. The patient showed progressive clinical improvement and was discharged on the sixth hospital day without complications or long-term sequelae