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It’s not all in ME mind, doc
  1. Esther Crawley1,
  2. Tim Chambers2
  1. 1Department of Paediatrics, Children’s Centre, Royal United Hospital, Bath, UK
  2. 2Southmead Hospital, Bristol, UK
  1. For correspondence:
    Dr Esther Crawley
    Department of Paediatrics, Children’s Centre, Royal United Hospital, Combe Park, Bath, BA1 3NG, UK; esther.crawleyruh-bath.swest.nhs.uk

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A 12 year old boy called John presents to his general practitioner (GP) with a two week history of sore throat and headaches. The GP examines John and notes that he is pale, has some tender lymphadenopathy, and a red throat.

The GP thinks this is either a viral sore throat, glandular fever, or maybe just a virus. He is concerned however as John doesn’t look well and is worried something else is going on. He explains that he thinks this is probably something like glandular fever but he would like to do some blood tests and would like to see John early next week. He takes blood for full blood count (FBC) and monospot, checks his liver function tests (LFTs) at the same time, and does a throat swab.

Next week John sees the GP again and nothing has changed very much. He thinks the headaches have got a bit worse. His back has started to hurt. There is nothing new to find on examination but the GP notes that the throat still looks red, and he still has cervical lymphadenopathy. This time the GP examines John’s optic discs, which are normal. He looks at his back, which has a full range of movement and no tender points.

The GP is not sure what is going on and still thinks John looks unwell. He suspects this is viral but is concerned as it has now been going on for three weeks. He reviews the blood tests which are: haemoglobin 11.9 g/l, mean corpuscular volume (MCV) 75 fl, total white cell count 6.5×109/l, normal differential; platelets 312×109/l, monospot negative, throat swab negative. The GP says that the blood tests are reassuring and that he thinks John has just had a nasty virus like glandular fever. He …

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