Objective Mononucleosis infectious (MI) is a generalised lymphoproliferative disorder most comonly coused by Epstein Barr virus (EBV). Acute hemolytic anemia is a rare complication, usually lasting for 1–2 months.

Aim We present a patient with acute MI complicated with hemolytic anemia.

Matherial Acute EBV MI was verified with a serologic ELISA test; IgM and IgG antibody against EBV VCA (viral capsid antigen) was used. We examined the patient clinically and with standard laboratory and other additional tests.

Results Patient BS, female, 15 years old, was admitted to the Infectious Disease Department with symptoms of weakness, chill, fever, sore throat and abdominal pain. Symptoms started 8 days earlier. Per examination: tonsillar enlargement with pus on the left, mild eye and skin jaundice, cervical lymphadenopathy, mild liver and spleen enlargement. MI was suspected. Laboratory tests showed inflammatory factors elevated with lymphocytes predominate, low RBC, HCT, HGB, with positive direct Coombs test. Liver enzymes (AST, ALT), lactate dehidrogenase, total bilirubin with unconjugated bilirubin were prediominately elevated. In the peripherial smear schistocytes, significant number of atypical lymphocites (30%) and reticulocytes were seen. Immunoserology analyses showed positive for ANA antibody.

Conclusion Four weeks after admission, the symptoms resolved. The patient become afebrile, without jaundice. The liver and spleen were near normal range. Liver enzymes and other laboratory findings were in regression. Direct Coombs test become negative. The patient was treeted with corticosteroides, antibiotics, iron and other symptomatic therapies.