Management of severe airway obstruction in a child with infectious mononucleosis.

Background. - Upper airway obstruction can represent a severe, life-threate ning complication of infectious mononucleosis. We report a rare case of air way obstruction in a child with infectious mononucleosis associated with he rpes virus infection, and we discuss management strategy that can be propos ed in such cases. Case report. - A 9-year-old girl was hospitalised in intensive care unit fo r obstructive dyspnea during infectious mononucleosis. Despite five days of corticosteroids and tracheal intubation, persistent pharyngo-tonsillar tum efaction led us to perform a surgical adenotonsillectomy. This latter treat ment allowed immediate tracheal extubation and a rapid recovery. Histology showed a herpes virus infection associated with infectious mononucleosis. Conclusion. - Maintaining airway opening in infectious mononucleosis needs sometimes to use instrumental interventions: nasal trumpet, endotracheal in tubation, even tracheostomy. Early tonsillo-adenoidectomy may relieve airwa y obstruction and allow a rapid recovery in the most severe cases. Airway o bstruction in infectious mononucleosis may be aggravated by concomitant her pes virus infection that should be searched for in this situation, in order to adapt the treatment. (C) 2001 Editions scientifiques et medicales Elsev ier SAS.