Gross Hematuria and Hemolytic Anemia: Complications in Infectious Mononucleosis

Infectious mononucleosis (IM), caused by the Epstein–Barr virus (EBV), typically manifests with fever, tonsillopharyngitis, and lymphadenopathy. Although rare, renal and hematological complications such as gross hematuria and hemolytic anemia can occur, particularly in children.

A 15-year-old male with IM presented with abdominal pain, sore throat, and red-colored urine for three days. The site of the abdominal pain was in the left upper quadrant, occasionally radiating to the groin, and was depicted as “cramping” and “sharp” in nature. There was no history of clot passage. 

 Laboratory tests showed leukocytosis, elevated liver enzymes, and hemoglobinuria. Serological testing confirmed an EBV infection. The patient had only mild anemia and responded effectively to supportive therapy despite having intravascular hemolysis.

There are few reports of hemolytic anemia and gross hematuria in IM. Autoimmune hemolysis and viral-induced kidney damage are two hypothesized pathways. Urine microscopy and serological testing can distinguish between different causes of hematuria, which should be taken into account in differential diagnosis. Patients with hematuria and pharyngitis should be evaluated for IM, particularly after ruling out other causes.

Source: Sharma C, Venugopal N, Balachandra S. Gross Hematuria and Hemolytic Anemia in Infectious Mononucleosis. Case Rep Pediatr. 2024 Sep 12;2024:5236969. doi: 10.1155/2024/5236969. PMID: 39301566; PMCID: PMC11412744.