LAUSR

observed. Bilateral mildly enlarged exudative tonsils were noted. He had mild submandibular lymphadenopathy (<1 cm). No other skin or mucous membrane changes were appreciated on examination. Cardiorespiratory and abdominal exam was unremarkable. Investigations included – full blood count, electrolytes and liver enzymes, C-reactive protein, viral serology (Cytomegalovirus, Ebstein-Barr virus (EBV), mycoplasma), lactate dehydrogenase, urine microscopy culture sensitivities, blood culture and oral swabs for Herpes simplex virus and enterovirus. The full blood count was unremarkable, C-reactive protein was <2, while there was a very mild transaminitis noted on liver function tests. Swabs for HSV and enterovirus were negative. Urine MCS was normal and the blood culture remained negative. EBV serology was positive for IgG and IgM suggestive of acute infection. The patient was managed with supportive measures receiving analgaesia and intravenous fluids. He was also given a total of three doses of oral dexamethasone with a resultant clinical improvement in the mucosal swelling 4 days after presentation to hospital. Manifestations of EBV infection in children can be heterogeneous. Mucocutaneous presentations are thought to occur in 3–15% of patients with primary infection, with this most commonly manifesting as a morbilliform rash or as a hypersensitivity reaction to antibiotics such as penicillins. Other mucocutaneous manifestations may include transient urticaria, erythema nodosum or Gianotti-Crosti syndrome/papular acrodermatitis of childhood. Mucous membrane involvement has been known to occur in the form of non-sexually related acute genital ulcers, generally occurring in adolescent females. No cases of prominent lip or tongue swelling could be found in the literature as a presentation of primary EBV infection. We therefore suggest this case as a unique presentation of EBV infection in childhood currently not represented in the medical literature.