Acute infectious mononucleosis presenting with palpebral and periorbital edema

Introduction: Almost all organs can be involved in the infection by Epstein-Barr virus and consequently, the beginning symptoms of infectious mononucleosis may be different. Materials and methods: We report a case of infection by Epstein-Barr virus in a 17-year-old girl whose primary manifestation was an initially monolateral and subsequently bilateral dacryoadenitis. Results: The incidence of acute dacryoadenitis by Epstein-Barr virus is valued around one case per million people per year, but it is probably underestimated: it is due to infiltration of the lacrimal gland by activated lymphocytes. Discussion: An acute dacryoadenitis, especially when it affects a young adult and when bilateral, should guide the diagnostic and haematochemical and serological investigations towards a systemic disease such as infectious mononucleosis. It is almost always responsive to a systemic corticosteroid therapy, but in some cases it can progress towards a dacryocystitis and exceptionally towards the Sjogren syndrome. Appropriate and timely treatment will be able to reduce any subsequent complications. (C) 2012 Elsevier Srl. All rights reserved.