{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:15:22Z","timestamp":1789748122758,"version":"4.0.1"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T00:00:00Z","timestamp":1665532800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T00:00:00Z","timestamp":1665532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Fonds de perfectionnement, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland"},{"name":"Fondation SICPA, Prilly, Switzerland"},{"name":"Fondazione Dr. Ettore Balli, Bellinzona, Switzerland"},{"name":"; Fondazione per il bambino malato della Svizzera italiana, Bellinzona, Switzerland"},{"name":"Frieda Locher-Hofmann Stiftung, Zu\u0308rich, Switzerland"},{"name":"Universit\u00e0 della Svizzera italiana"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The typical presentation of Epstein\u2013Barr virus infectious mononucleosis includes fever, pharyngitis, measles-like rash, jaundice, and enlarged lymph nodes, liver, or spleen. A painless bilateral swelling of the upper eyelid, sometimes with drooping of the lateral aspect, may also occur. This sign, referred to as Hoagland sign, is not or only marginally mentioned in reviews and textbooks.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Between 2019 and 2021, two of us evaluated all subjects with a positive acute Epstein\u2013Barr virus serology for the typical signs of mononucleosis and for the possible existence of the Hoagland sign.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>During the mentioned period, the diagnosis of mononucleosis was made in 26 (14 females and 12 males) subjects aged from 9.0 to 33\u00a0years. The initial presentation included fever in 24, enlarged cervical lymph nodes in 23, pharyngitis in 21, a palpable liver in 7, a palpable spleen in 7, jaundice in 2, and a measles-like rash in 2 cases. The Hoagland sign was noted in 14 cases. Patients with and without Hoagland sign did not significantly differ with respect to age and sex.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The Hoagland sign is an easily identifiable clinical sign that is common and likely helpful early in the course of Epstein\u2013Barr virus infectious mononucleosis. There is a need to expand awareness of this sign among physicians.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s15010-022-01932-6","type":"journal-article","created":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T17:03:08Z","timestamp":1665594188000},"page":"471-474","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Bilateral upper eyelid swelling (Hoagland sign) in Epstein\u2013Barr infectious mononucleosis: prospective experience"],"prefix":"10.1007","volume":"51","author":[{"given":"Gabriel","family":"Bronz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetto P. E. S. M.","family":"Zanetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario G.","family":"Bianchetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregorio P.","family":"Milani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiano A. G.","family":"Lava","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Neuhaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Witschi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Kottanattu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,10,12]]},"reference":[{"key":"1932_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/S0011-5029(74)80012-X","volume":"20","author":"PA Chervenick","year":"1974","unstructured":"Chervenick PA. Infectious mononucleosis. Dis Mon. 1974;20:1\u201329. https:\/\/doi.org\/10.1016\/S0011-5029(74)80012-X.","journal-title":"Dis Mon"},{"key":"1932_CR2","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1056\/NEJM200008173430707","volume":"343","author":"JI Cohen","year":"2000","unstructured":"Cohen JI. Epstein-Barr virus infection. N Engl J Med. 2000;343:481\u201392. https:\/\/doi.org\/10.1056\/NEJM200008173430707.","journal-title":"N Engl J Med"},{"key":"1932_CR3","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.jcv.2018.03.001","volume":"102","author":"SK Dunmire","year":"2018","unstructured":"Dunmire SK, Verghese PS, Balfour HH Jr. Primary Epstein-Barr virus infection. J Clin Virol. 2018;102:84\u201392. https:\/\/doi.org\/10.1016\/j.jcv.2018.03.001.","journal-title":"J Clin Virol"},{"key":"1932_CR4","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/0002-9343(52)90154-X","volume":"13","author":"RJ Hoagland","year":"1952","unstructured":"Hoagland RJ. Infectious mononucleosis. Am J Med. 1952;13:158\u201371. https:\/\/doi.org\/10.1016\/0002-9343(52)90154-X.","journal-title":"Am J Med"},{"key":"1932_CR5","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1001\/archotol.133.1.61","volume":"133","author":"DM Wolf","year":"2007","unstructured":"Wolf DM, Friedrichs I, Toma AG. Lymphocyte-white blood cell count ratio: a quickly available screening tool to differentiate acute purulent tonsillitis from glandular fever. Arch Otolaryngol Head Neck Surg. 2007;133:61\u20134. https:\/\/doi.org\/10.1001\/archotol.133.1.61.","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"1932_CR6","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1177\/000992288502400905","volume":"24","author":"GW Brown","year":"1985","unstructured":"Brown GW, Hayden GF. Nonparametric methods. Clinical applications. Clin Pediatr (Phila). 1985;24:490\u20138. https:\/\/doi.org\/10.1177\/000992288502400905.","journal-title":"Clin Pediatr (Phila)"},{"key":"1932_CR7","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1097\/ICU.0b013e3283560ace","volume":"23","author":"RK Sobel","year":"2012","unstructured":"Sobel RK, Carter KD, Allen RC. Periorbital edema: a puzzle no more? Curr Opin Ophthalmol. 2012;23:405\u201314. https:\/\/doi.org\/10.1097\/ICU.0b013e3283560ace.","journal-title":"Curr Opin Ophthalmol"},{"key":"1932_CR8","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/s0161-6420(99)00014-7","volume":"107","author":"AS Feinberg","year":"2000","unstructured":"Feinberg AS, Spraul CW, Holden JT, Grossniklaus HE. Conjunctival lymphocytic infiltrates associated with Epstein-Barr virus. Ophthalmology. 2000;107:159\u201363. https:\/\/doi.org\/10.1016\/s0161-6420(99)00014-7.","journal-title":"Ophthalmology"},{"key":"1932_CR9","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1016\/s0161-6420(96)30617-9","volume":"103","author":"NS Aburn","year":"1996","unstructured":"Aburn NS, Sullivan TJ. Infectious mononucleosis presenting with dacryoadenitis. Ophthalmology. 1996;103:776\u20138. https:\/\/doi.org\/10.1016\/s0161-6420(96)30617-9.","journal-title":"Ophthalmology"},{"key":"1932_CR10","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/s0002-9394(99)00351-7","volume":"129","author":"MN Rhem","year":"2000","unstructured":"Rhem MN, Wilhelmus KR, Jones DB. Epstein-Barr virus dacryoadenitis. Am J Ophthalmol. 2000;129:372\u20135. https:\/\/doi.org\/10.1016\/s0002-9394(99)00351-7.","journal-title":"Am J Ophthalmol"}],"container-title":["Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-022-01932-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s15010-022-01932-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-022-01932-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T10:19:19Z","timestamp":1679912359000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s15010-022-01932-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,12]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["1932"],"URL":"https:\/\/doi.org\/10.1007\/s15010-022-01932-6","relation":{},"ISSN":["0300-8126","1439-0973"],"issn-type":[{"value":"0300-8126","type":"print"},{"value":"1439-0973","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,12]]},"assertion":[{"value":"7 August 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 September 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Gabriel Bronz, Benedetto P. E. S. M. Zanetti, Mario G. Bianchetti, Gregorio P. Milani, Sebastiano A. G. Lava, Thomas J. Neuhaus, Anne Witschi and Lisa Kottanattu declared that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed were in accordance with ethical standards as laid down in the 1964 Helsinki Declaration.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for participation"}},{"value":"Data were obtained from the results of an observational study of anonymized \u201cminimal clinical data\u201d, with intimation to all patients that the results would be published. No personal identifying information was requested, consent was implied. A written informed consent has been obtained\u00a0from the patient for publication of the pictures.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}