Acute infectious mononucleosis presenting with palpebral and periorbital edema

Introduction Almost all organs can be involved in the infection by Epstein–Barr virus and consequently, the beginning symptoms of infectious mononucleosis may be different.Materials and methods We report a case of infection by Epstein–Barr virus in a 17-year-old girl whose primary manifestation was an initially monolateral and subsequently bilateral dacryoadenitis.Results The incidence of acute dacryoadenitis by Epstein–Barr virus is valued around one case per million people per year, but it is probably underestimated: it is due to infiltration of the lacrimal gland by activated lymphocytes.Discussion An acute dacryoadenitis, especially when it affects a young adult and when bilateral, should guide the diagnostic and haematochemical and serological investigations towards a systemic disease such as infectious mononucleosis. It is almost always responsive to a systemic corticosteroid therapy, but in some cases it can progress towards a dacryocystitis and exceptionally towards the Sjogren syndrome. Appropriate and timely treatment will be able to reduce any subsequent complications.