Anna, a 18-year-old college soccer player is seen in your office with a complaint of a persistent severely sore throat

Anna, a 18-year-old college soccer player is seen in your office with a complaint of a persistent severely sore throat and a full-body rash. She was seen at the college medical center 3 days ago and was diagnosed with strep throat as identified by a positive rapid strep test. She was prescribed Amoxicillin 875 mg BID x 10 days. Anna reports a 3-week history of fever between 38.3 to 38.9 degree celsius, lethargy, upper quadrant abdominal discomfort with trunk movement (without vomiting, diarrhea or nausea) and fatigue. Physical examination reveals marked cervical and inguinal adenopathy, enlarged tonsils with exudate, small petecchial hemorrhages on the soft palate and a palpable spleen 2 cm below the left costal margin. Anna reports teammates recently having strep throat; she does not know of anyone recently diagnosed with mono. Recent travel has been local for indoor soccer games. Anna does report that she is dating a hockey player who had been diagnosed with mono but that was about 5 months ago.

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