A Man With Tonsillitis and Hepatitis

A previously well Australian-born 28-year-old gentleman was diagnosed with a stage 1 non-seminomatous testicular cancer, for which he underwent a left radical orchidectomy, followed by a single cycle of adjuvant chemotherapy with bleomycin, etoposide and cisplatin. One week later, he presented to hospital with a one-day history of fevers, rigors and severe sore throat. There was no recent travel or animal contact, nor was there any risk factor for blood-borne viruses. He had recently entered into a new relationship with a female partner. On physical examination he was noted to have bilateral swollen, erythematous tonsils with exudates, associated with bilateral tender cervical lymphadenopathy. No visible mucocutaneous vesicles or ulcers were found. Initial investigation results showed neutrophilia of 13.4 × 10^9/L (2.0–8.0) but lymphopenia of 0.4 × 10^9/L (1.0–4.0), and a normal liver function test. Blood film demonstrated toxic changes of leukocytes with occasional reactive lymphocytes. Heterophile antibody test for infectious mononucleosis was negative. He was given penicillin following which he developed a widespread blanching macular rash two days later. He was then discharged home.