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A previously well 33-year-old man was admitted to hospital with a 2-week history of intermittent fever and inguinal lymphadenopathy and a 2-day history of jaundice. Acute hepatitis due to Epstein–Barr virus (EBV) infection was diagnosed based on a positive Paul–Bunnell test result and EBV immunoglobulins G and M and exclusion of other causes (see supplementary data). He was managed conservatively and discharged home after 2 weeks.
Three days after discharge, he developed left-sided facial weakness. He was seen in the medical outpatient clinic and found to have a left-sided facial nerve paresis. He was referred to the hospital 4 days later with worsening facial weakness. On examination, there was bilateral facial nerve paresis, worse on the left than the …
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