Letters, calls and emails: Thrombocytopenia always needs steroids

Dear Editor

Dr Julia Markham does not mention thrombocytopenia in her article on glandular fever, which always needs steroids.

There is also a good case for prescribing steroids with persistent fever and malaise and a positive monospot test.

Fever is not caused by the virus at this stage, but by an autoimmune response. This has been shown to be triggered by the existence of a shared epitope of the Epstein-Barr virus protein and human spliceosomal protein that is produced in tissues undergoing cell division such as the tissues of the pharynx, spleen, liver and bone marrow.

Trials of steroids in GF have shown rapid disappearance of fever and clinical improvement and I have seen this many times.

I usually start the patient on erythromycin while awaiting blood tests. More severe cases should continue erythromycin as well as being started on 10 days of prednisolone.

Dr John A A Nichols,
Guildford, Surrey

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