Epstein-Barr Virus (EBV) Infectious Mononucleosis (Mono) Differential Diagnoses

Updated: Apr 21, 2021
  • Author: Kartika Shetty, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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DDx

Diagnostic Considerations

EBV-negative Mononucleosis

Approximately 10 percent of mononucleosis-type cases are not caused by EBV. CMV, HIV, Toxoplasma, human herpesvirus type 6 (HHV-6), hepatitis B and HHV-7 present similarly to EBV induced IM and should be considered in a heterophile-negative mononucleosis-like syndrome.

    Table 1. Differential Diagnoses of Infectious Mononucleosis (Open Table in a new window)

Clinical Parameters

Epstein-Barr Virus

Cyto-megalovirus

Toxoplasmosis

Viral Hepatitis

Symptoms

Fatigue

+++

+

+/-

+

Malaise

++

+

-

+

Mild sore throat

+

+

+/-

+/-

Early maculopapular rash

±

-

-

+/-

Signs

Early bilateral upper eyelid edema

±

-

-

-

Unilateral localized adenopathy

-

-

+

-

Bilateral posterior cervical adenopathy

+

+

-

+/-

Tender hepatomegaly

+/-

+/-

-

+

Splenomegaly

+

+/-

+/-

-

Laboratory abnormalities

WBC count

N*/-

N/-

N

¯

Elevated SGOT/SGPT

++

+

+/-

+++

Atypical lymphocytes (≥ 10%)

+

+

-

-

Thrombocytopenia

+/-

+/-

-

+/-

Elevated IgM§ CMV titer

-

+

-

-

Elevated IgM EBV VCAII titer

+

-

-

-

Elevated IgM toxoplasmosis titer

-

-

+

-

Positive hepatitis (eg, A, B, D) test

-

-

-

+

*Normal

 Serum glutamic-oxaloacetic transaminase

 Serum glutamic-pyruvic transaminase

§ Immunoglobulin M

II Viral capsid antigen