{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:12:43Z","timestamp":1791562363279,"version":"4.3.4"},"reference-count":20,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Infectious mononucleosis (IM) is a viral disease most commonly caused by the Epstein\u2013Barr virus (EBV). The triad of fever, pharyngitis, and cervical chain lymphadenopathy classically describe this benign condition. Ocular association is also possible, although less commonly reported, and manifests as bilateral periorbital oedema presenting early in the disease process. A case of a fit and well 18-year-old female patient who developed periorbital oedema before the classic triad is presented. Furthermore, her case describes a significantly longer duration of periorbital tissue involvement, contrary to what is described in the current literature. Clinicians should not only recognise periorbital oedema as an initial manifestation of IM but also be alerted of its possible protracted course.<\/jats:p>","DOI":"10.3390\/idr14060092","type":"journal-article","created":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T03:48:12Z","timestamp":1669175292000},"page":"942-945","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Protracted Course of Periorbital Oedema in Infectious Mononucleosis Caused by Epstein\u2013Barr Virus"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8808-2287","authenticated-orcid":false,"given":"Daryl","family":"Ricardo","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, St. George\u2019s University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1080\/09674845.2021.1903683","article-title":"Infectious Mononucleosis: Diagnosis and clinical interpretation","volume":"78","author":"Naughton","year":"2021","journal-title":"Br. J. Biomed. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Bronz, G., Zanetti, B., and Bianchetti, M. (2022). Bilateral upper eyelid swelling (Hoagland sign) in Epstein-Barr infectious mononucleosis: Prospective experience. Infection, 1\u20134.","DOI":"10.21203\/rs.3.rs-1938122\/v1"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e233719","DOI":"10.1136\/bcr-2019-233719","article-title":"Upper eyelid oedema in a patient with pharyngitis\/exudative tonsillitis and malaise: Hoagland sign in infectious mononucleosis","volume":"12","author":"Louppides","year":"2019","journal-title":"BMJ Case Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e250857","DOI":"10.1136\/bcr-2022-250857","article-title":"Hoagland sign: Bilateral upper eyelid oedema","volume":"15","author":"Otsuka","year":"2022","journal-title":"BMJ Case Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.3904\/kjim.2020.350","article-title":"Infectious Mononucleosis with Eyelid Edema and Palatal Petechiae","volume":"36","author":"Nakagawa","year":"2020","journal-title":"Korean J. Intern. Med."},{"key":"ref_6","first-page":"211","article-title":"Infectious Mononucleosis","volume":"390","author":"Dunmire","year":"2015","journal-title":"Curr. Top Microbiol. Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/0002-9343(52)90154-X","article-title":"Infectious mononucleosis","volume":"13","author":"Hoagland","year":"1952","journal-title":"Am. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S0022-3476(54)80144-2","article-title":"Periorbital edema as the initial sign of infectious mononucleosis","volume":"45","author":"Bass","year":"1954","journal-title":"J. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"152","DOI":"10.5505\/kjms.2013.02886","article-title":"Association of Periorbital Edema and Fever in Acute Infectious Mononucleosis: A Case Report","volume":"3","author":"Kaptanoglu","year":"2013","journal-title":"Kafkas J. Med. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1055\/s-2005-858546","article-title":"Beidseitige Oberlidschwellung bei Mononucleosis Infectiosa (Hoagland-Zeichen)","volume":"222","author":"Burger","year":"2005","journal-title":"Klin. Monatsbl. Augenheilkd."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/S0161-6420(96)30617-9","article-title":"Infectious Mononucleosis Presenting with Dacryoadenitis","volume":"103","author":"Aburn","year":"1996","journal-title":"Ophthalmology"},{"key":"ref_12","first-page":"400","article-title":"Hoagland Sign: An early manifestation of acute infectious mononucleosis\u2014A case report","volume":"21","author":"Sawant","year":"2017","journal-title":"Curr. Pediatr. Res."},{"key":"ref_13","first-page":"338","article-title":"Periorbital oedema","volume":"67","author":"Schreuder","year":"2009","journal-title":"Neth. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1007\/s15010-013-0487-y","article-title":"Three cases of primary EBV infection in young adults manifested by periorbital and eye-lid oedema","volume":"41","author":"Demonchy","year":"2008","journal-title":"Infection"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1001\/archotol.131.10.900","article-title":"Infectious Mononucleosis and Corticosteroids","volume":"131","author":"Thompson","year":"2005","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.survophthal.2007.04.006","article-title":"Fever and Periorbital Edema: A Review","volume":"52","author":"Rafailidis","year":"2007","journal-title":"Surv. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ejim.2018.09.004","article-title":"Angioedema and emergency medicine: From pathophysiology to diagnosis and treatment","volume":"59","author":"Depetri","year":"2019","journal-title":"Eur. J. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"56","DOI":"10.2298\/SARH1602056M","article-title":"Clinical and laboratory differences between Epstein-Barr and cytomegalovirus infectious mononucleosis in children","volume":"144","year":"2016","journal-title":"Srpski Arhiv Celokupno Lekarstvo"},{"key":"ref_19","first-page":"33","article-title":"Clinical presentation & management of glomerular diseases: Hematuria, nephritic & nephrotic syndrome","volume":"108","author":"Khanna","year":"2011","journal-title":"Mo Med."},{"key":"ref_20","first-page":"445","article-title":"Infectious mononucleosis and mononucleosis syndromes","volume":"126","author":"Fiala","year":"1977","journal-title":"West J. Med."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/14\/6\/92\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:24:45Z","timestamp":1760145885000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/14\/6\/92"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,23]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["idr14060092"],"URL":"https:\/\/doi.org\/10.3390\/idr14060092","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,23]]}}}