Conjunctival tumour as the primary manifestation of infectious mononucleosis in a 12 year old girl

Editor,—Infectious mononucleosis (IM), a common disease in childhood, is an acute lymphoproliferative disease caused by Epstein–Barr virus (EBV),1 a member of the herpes virus family. The association of EBV infection with benign and malignant lymphoproliferative diseases, as well as its role in the pathogenesis of nasopharyngeal carcinoma, is well known.2 3 The course of IM is usually self limiting but can be extremely variable, ranging from asymptomatic to a fatal outcome. Fever, pharyngitis, lymphadenopathy, and hepatosplenomegaly are typical systemic manifestations. Essential for the diagnosis is an increase in relative and absolute numbers of lymphocytes and monocytes, including 20–40% atypical forms. Ocular involvement of IM is unusual and occurs often as a mild unilateral follicular conjunctivitis simultaneously with these other symptoms.4 We describe a girl with a conjunctival tumour as the first manifestation of IM; systemic symptoms of the disease occurred some days later.