Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, EOC, Bellinzona, Switzerland.
Faculty of Biomedical Sciences, Università della Svizzera Italiana, USI, Lugano, Switzerland.
Infection. 2023 Apr;51(2):471-474. doi: 10.1007/s15010-022-01932-6. Epub 2022 Oct 12.
The typical presentation of Epstein-Barr 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.
Between 2019 and 2021, two of us evaluated all subjects with a positive acute Epstein-Barr virus serology for the typical signs of mononucleosis and for the possible existence of the Hoagland sign.
During the mentioned period, the diagnosis of mononucleosis was made in 26 (14 females and 12 males) subjects aged from 9.0 to 33 years. 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.
The Hoagland sign is an easily identifiable clinical sign that is common and likely helpful early in the course of Epstein-Barr virus infectious mononucleosis. There is a need to expand awareness of this sign among physicians.
EB 病毒传染性单核细胞增多症的典型表现包括发热、咽炎、麻疹样皮疹、黄疸以及淋巴结、肝脏或脾脏肿大。上眼睑无痛性双侧肿胀，有时外侧下垂，也可能发生。这种被称为霍格兰（Hoagland）征的体征在综述和教科书中没有或仅略有提及。
在 2019 年至 2021 年期间，我们中的两位评估了所有急性 EBV 血清学阳性的患者，以确定单核细胞增多症的典型体征和可能存在的霍格兰征。
在所述期间，26 名（14 名女性和 12 名男性）年龄在 9.0 至 33 岁的患者被诊断为单核细胞增多症。最初的表现包括 24 例发热、23 例颈淋巴结肿大、21 例咽炎、7 例可触及肝脏、7 例可触及脾脏、2 例黄疸和 2 例麻疹样皮疹。14 例患者出现霍格兰征。有和没有霍格兰征的患者在年龄和性别方面没有显著差异。
霍格兰征是一种易于识别的临床体征，在 EB 病毒传染性单核细胞增多症的早期很常见，可能有助于早期诊断。有必要提高医生对这一征象的认识。
