Complications of Glandular Fever
While the majority of people recover from glandular fever without lasting effects, there are some rare but serious complications to be aware of. Glandular fever, caused by the Epstein-Barr virus, is usually self-limiting and resolves with supportive care. However, the virus can occasionally affect other organs or systems, especially if the immune response is unusually strong or if rest is not adequately observed during recovery.
Knowing the potential complications of glandular fever can help patients and healthcare providers act swiftly when red flags appear. Fortunately, with timely intervention, most complications are treatable and do not result in long-term harm.
1. Enlarged or Ruptured Spleen
Splenomegaly—an enlarged spleen—is common in glandular fever and occurs in up to 50% of cases. It usually causes:
Fullness or pain in the upper left abdomen
Tenderness, especially when lying down
A feeling of pressure after eating
The most serious risk is spleen rupture, which is rare (around 1 in 1,000 cases) but potentially life-threatening. Signs include:
Sudden sharp pain in the left side
Dizziness or fainting
Rapid heart rate or low blood pressure
To prevent rupture, patients should avoid:
Contact sports
Heavy lifting
Strenuous activity for at least 4 weeks post-diagnosis
2. Liver Inflammation (Hepatitis)
Mild liver inflammation is common and may cause:
Elevated liver enzymes on blood tests
Tenderness in the upper right abdomen
Nausea or reduced appetite
In some cases, jaundice
This form of hepatitis is self-limiting and resolves without treatment. However, liver function should be monitored, especially if symptoms are severe or prolonged.
3. Airway Obstruction
Swelling of the tonsils and surrounding tissues may lead to:
Difficulty breathing or swallowing
Snoring or sleep apnoea
Muffled voice
Severe obstruction may require:
Corticosteroids to reduce swelling
Hospital monitoring for airway support
Intravenous fluids if eating or drinking is impaired
This is a rare complication but needs immediate attention if breathing is affected.
4. Anaemia and Low Platelet Count
In some people, EBV may cause:
Haemolytic anaemia, where red blood cells break down prematurely
Thrombocytopaenia, a low platelet count
Symptoms include:
Fatigue, pale skin
Easy bruising or bleeding
Prolonged bleeding from cuts or nosebleeds
These issues usually resolve on their own but should be monitored with blood tests if suspected.
5. Neurological Complications
Very rarely, glandular fever may affect the nervous system. Possible conditions include:
Meningitis
Encephalitis (brain inflammation)
Guillain-Barré syndrome
Bell’s palsy (facial paralysis)
Warning signs include:
Severe headache
Neck stiffness
Seizures
Confusion or hallucinations
Urgent hospital evaluation is needed in any of these scenarios. These complications are extremely rare but potentially serious.
6. Chronic Fatigue Syndrome (CFS/ME)
A small number of individuals develop post-viral fatigue that lasts for months. In some cases, it meets the criteria for chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME). Characteristics include:
Persistent exhaustion not improved by rest
Cognitive issues (brain fog)
Sleep disturbances
Muscle or joint pain
While no cure exists, supportive treatments like pacing, physiotherapy, and psychological support can improve quality of life.
7. Secondary Infections
During or shortly after glandular fever, the immune system may be temporarily weakened, increasing susceptibility to:
Bacterial tonsillitis
Sinus infections
Chest infections
These may require antibiotics or further investigation if symptoms worsen or change unexpectedly.
Summary of Possible Complications
| Complication | Frequency | Seriousness |
| Spleen rupture | Rare | Medical emergency |
| Liver inflammation | Common (mild) | Usually self-limited |
| Airway obstruction | Rare | May need steroids or hospital care |
| Anaemia/thrombocytopaenia | Uncommon | Monitor with tests |
| Neurological issues | Very rare | Potentially serious |
| Chronic fatigue | Small percentage | Long-term support |
| Secondary infections | Occasionally seen | Easily treatable |
Conclusion | Complications of Glandular Fever
The complications of glandular fever are uncommon but can become serious if not recognised early. Spleen rupture, airway obstruction, and post-viral fatigue are the most important risks to be aware of. By resting properly, monitoring symptoms, and seeking medical help when necessary, most individuals recover completely and return to normal life without lasting effects.
