Aplastic Anemia Complicating Infectious Mononucleosis: A Case Report and Review of the Literature

A 12 1/2-year-old white girl developed pancytopenia and severe aplastic anemia three weeks following symptoms of infectious mononucleosis. Pancytopenia complicating infectious mononucleosis has been reported in only nine previous cases and only three were proven to have aplastic anemia. The mean time from onset of symptoms of infectious mononucleosis to the nadir of pancytopenia was 21.3 days with a range of seven to 49 days. Two patients died from complications of the pancytopenia. In those patients who recovered, the mean time from diagnosis of the pancytopenia to recovery of bone marrow function was 6.25 days with a range of four to eight days. In contrast to other causes of aplastic anemia, return of normal platelet levels coincided with recovery from pancytopenia. The etiology of the pancytopenia and aplastic anemia are unknown but immunologic causes are suspected because of the rapid recovery of the bone marrow and its possible responsiveness to steroids.