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

Abstract

Infectious mononucleosis is characterized by the triad of fever, pharyngotonsillitis and cervical lymphadenopathy. However, some early manifestations, such as bilateral eyelid edema (Hoagland’s sign), may go unnoticed, especially in the pediatric population, leading
to diagnostic delays and the unnecessary use of antibiotics. Case presentation. A 7-year-old female patient presented with acute, non-inflammatory bilateral eyelid edema that was painless and lacked local signs of inflammation, accompanied by fever, pharyngotonsillitis,
and cervical lymphadenopathy. The identification of Hoagland’s sign led to an early suspicion of Epstein-Barr virus infection. A complete blood count with peripheral blood smear revealed 15 % reactive atypical lymphocytes, a hematologic finding characteristic of the disease. A cervical ultrasound showed multiple bilateral enlarged lymph nodes in the anterior and posterior cervical chains. Diagnosis. The diagnosis was confirmed by the
detection of heterophile antibodies during the second week of the illness. Treatment. Symptomatic treatment with nonsteroidal anti-inflammatory drugs was prescribed; corticosteroids, antivirals, or antibiotics were not required. Clinical evolution. The course was favorable, with progressive resolution of symptoms. The patient was discharged on the sixth hospital day , with no complications or sequelae during follow-up. Recognition of Hoagland’s sign can facilitate a timely diagnosis and appropriate management.