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Ruptured spleen: Many patients with mononucleosis caused by the Epstein-Barr virus (EBV) develop an enlarged spleen. In extreme cases, the spleen may rupture. This is most likely to happen if the person participates in rigorous physical activities while he/she is sick. Patients who rupture their spleens typically experience a sharp and sudden pain in the upper-left side of the abdomen. If this type of pain develops, patients should be taken to the nearest hospital immediately. A ruptured spleen generally requires surgery.
Nerve problems: Complications of the nervous system are rare, but may include nerve damage, seizures, behavioral changes, inflammation of the brain (called encephalitis), and inflammation of the tissues surrounding the brain and spinal cord (called meningitis).
Blocked airways: In rare cases, the lymph nodes in the neck may become extremely large and block the airways. This may make it difficult for the patient to breathe.
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Epstein-Barr virus can become latent or dormant in your body after exposure. This situation can persist for years, much like the chicken-pox virus which can persist for years in the nerve cells and then produce shingles at a later date. In the case of Epstein-Barr virus, it can re-activate or be persistent (for example Nicolas et al, Biomed J, 2014 demonstrated reactivation in immunocompetent patients following an unrelated critical illness, but also see review by Murata et al., Microbiol Immunol. 2014 Jun;58(6):307-17). EBV has been strongly associated with Chronic Fatigue Syndrome in studies from Stanford and elsewhere (see: Kogelnik et al. J Clin Virol. December 2006;37(suppl 1):S33-S38; Lerner et al. Drugs Today (Barc). 2002;38(8):549-561; Broderick et al. J Transl Med. 2012 Sep 13;10:191; Lerner et al. In Vivo. 2007;21(5):707-713). Symptoms of Chronic Fatigue Syndrome can include fatigue, increased amount of sleep, disrupted sleep, waking unrested from sleep, joint pain, flu-like symptoms, loss of interest in formerly enjoyed activities (due to insufficient energy), painful lymph nodes, muscle pain, and malaise after exertion. It is not unusual for this set of symptoms to be confused with depression according to research I have published (see: Henderson, Adv Mind Body Med. 2014 Winter;28(1):4-14).
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