Infectious Mononucleosis (IM) in Emergency Medicine Treatment & Management

Updated: Nov 11, 2022
  • Author: Michael S Omori, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Emergency Department Care

Treatment of patients with infectious mononucleosis (IM) generally is supportive, consisting primarily of rest, analgesics, and antipyretics. [1]

Because of the risk of splenic rupture, health care providers should avoid vigorous abdominal examination and palpation in patients with infectious mononucleosis.

Certain clinical situations may warrant the administration of corticosteroids. Several studies have suggested that corticosteroids may be beneficial to patients with infectious mononucleosis, but the routine use of these agents in patients with uncomplicated disease should be avoided because these medications may adversely affect cell-medicated immune responses, thereby increasing the risk of bacterial superinfection.

Patients with complications due to infectious mononucleosis who may benefit from corticosteroids include those with massive edema of the Waldeyer ring with a potential for airway obstruction, patients with autoimmune hemolytic anemia, or those with severe thrombocytopenia.

Other complications that may warrant such therapy include severe involvement of the heart or central nervous system (CNS).



Appropriate consultations should be obtained in patients with infectious mononucleosis who have significant complications or in cases that present in an atypical fashion, suggesting another serious process.



The ubiquitous nature of Epstein-Barr virus (EBV) coupled with its typically benign and self-limited course renders deterrence a moot issue.


Long-Term Monitoring

Patients with uncomplicated infectious mononucleosis should be advised to avoid participation in contact sports or vigorous exercise for at least one month due to the potential for splenic rupture.

Routine follow-up care with primary care physicians is recommended to monitor symptomatic improvement and to watch for the development of complications.


Further Inpatient Care

Admission rarely is necessary in patients with uncomplicated infectious mononucleosis.

Circumstances that warrant inpatient treatment include serious complications, as detailed below.