Enlarged tonsils, exudates, and petechiae of the palate are classic for infection with which organism?

Enlarged tonsils, exudates, and petechiae of the palate are classic for infection with which organism?

• A. Epstein-Barr Virus
• B. Streptococcus pyogenes
• C. Cytomegalovirus
• D. Adenovirus

Answer: (A)

Palatal petechiae with enlarged tonsils and exudates is most characteristic of infectious mononucleosis caused by Epstein-Barr virus. This combination of findings—pharyngitis with tonsillar exudates and tiny red spots on the palate—fits the classic EBV presentation, which also often includes fatigue, fever, and posterior cervical lymphadenopathy, sometimes with hepatosplenomegaly. Other causes of sore throat with exudates can occur, but they don’t typically produce the same palatal petechiae pattern. Streptococcal pharyngitis can have exudates but usually shows anterior cervical lymphadenopathy and lacks the palatal petechiae that point toward EBV. Cytomegalovirus can mimic mono in some patients, but palatal petechiae are less common. Adenovirus can cause exudative pharyngitis as well, yet the distinctive palatal petechiae are not a hallmark. If EBV mono is suspected, testing for heterophile antibodies or EBV serology can help confirm, and it’s important to avoid ampicillin or amoxicillin if antibiotics are used, as a classic diffuse rash can develop.

Palatal petechiae with enlarged tonsils and exudates is most characteristic of infectious mononucleosis caused by Epstein-Barr virus. This combination of findings—pharyngitis with tonsillar exudates and tiny red spots on the palate—fits the classic EBV presentation, which also often includes fatigue, fever, and posterior cervical lymphadenopathy, sometimes with hepatosplenomegaly.

Other causes of sore throat with exudates can occur, but they don’t typically produce the same palatal petechiae pattern. Streptococcal pharyngitis can have exudates but usually shows anterior cervical lymphadenopathy and lacks the palatal petechiae that point toward EBV. Cytomegalovirus can mimic mono in some patients, but palatal petechiae are less common. Adenovirus can cause exudative pharyngitis as well, yet the distinctive palatal petechiae are not a hallmark.

If EBV mono is suspected, testing for heterophile antibodies or EBV serology can help confirm, and it’s important to avoid ampicillin or amoxicillin if antibiotics are used, as a classic diffuse rash can develop.