13 Signs and Symptoms of Mononucleosis
If you’ve been battling persistent fatigue, a sore throat, or swollen neck lumps, you might wonder if it’s just a passing cold—or something more. Ignoring these symptoms risks overlooking a long-term infection.
Mononucleosis (“mono”)—often linked to the Epstein-Barr virus (EBV)—frequently affects teens and young adults, especially in close-contact settings like college campuses. The virus spreads quickly through saliva, whether from kissing, sharing drinks or exposure to an infected person’s cough or sneeze.
Understanding mononucleosis also enables you to recognize potential complications, and early recognition of the illness helps limit its impact on your life while reducing transmission risks to others.
Common Symptoms
Mononucleosis may not always cause noticeable symptoms, and infected individuals can spread the virus weeks before any signs appear. However, symptoms develop as a result of the immune system’s response to the infection.
Extreme Fatigue
Extreme fatigue that persists despite rest and sleep is a defining symptom of mono. This makes even simple tasks feel exhausting, as your energy is diverted to fighting the infection and coping with other symptoms experienced.
You might notice that climbing a short flight of stairs leaves you short of breath or that you’re longing for a nap after running a quick errand. Cooking, studying, answering emails, and even taking a shower may take more effort than usual.
As a result, you might need longer rest periods and breaks throughout the day. Without rest, you may find it harder to stay alert when focusing on work, school, or conversations.
Fever
Fever is another sign of the body’s immune response to the virus. It often manifests as an elevated body temperature that can fluctuate throughout the day. As your body attempts to regulate its temperature, you might feel unusually warm or experience chills.
This can sometimes lead to increased sweating and clammy skin. Fatigue, headaches, and general discomfort related to the fever are also common during these episodes.
Some individuals wake up at night feeling sweaty or flushed, then cool down and feel more stable hours later. This cycle can last up to 14 days as the body continues fighting the infection.
Sore Throat
A sore throat in mononucleosis can feel more intense than the typical scratchiness you get with a common cold. You might notice that each swallow brings a sharp or scratchy sensation, as your throat may feel persistently dry.
This discomfort is often due to inflammation triggered by your immune system’s response to the viral infection. Swollen tonsils can worsen the soreness, and talking or eating may become more challenging due to the throat’s sensitivity.
Swollen Neck Lumps
Swollen lymph nodes are another clear indicator of your immune system’s response to an infection. They often present as tender lumps in the neck—especially near the jaw or behind the ears—and may also develop in the armpits.
You may find that turning your head, raising your shoulders, or lifting your arms feels tight or uncomfortable. Swelling is often worse on one side, and the nodes may feel sore or tender if pressed or accidentally bumped during normal daily activities.
Enlarged Tonsils
Your tonsils may become enlarged or inflamed, sometimes developing white or yellowish patches. This condition can cause discomfort while swallowing and create a persistent lump-like sensation in your throat.
Some individuals experience a sharp ache when drinking liquids or speaking for extended periods, while others notice a lingering scratchiness. The inflammation with dryness can also make the tonsils more tender, increasing throat discomfort.
Less Common Additional Symptoms
Mononucleosis can remain contagious even after initial symptoms improve- for three months or longer. During this time, other less common symptoms may develop and cause further discomfort.
Headache
Headaches ranging from mild discomfort to more persistent pain may occur and interfere with daily activities. You might feel a dull pressure behind the eyes or near the temples.
Others describe a subtle throbbing that worsens throughout the day and increases with stress or lack of sleep, which sometimes accompanies a low-grade fever and flu-like symptoms.
These headaches may heighten sensitivity to light or noise, making specific environments more uncomfortable, and can occasionally occur with brief episodes of dizziness.
Muscle Aches & Weakness
You may notice your muscles feeling sore or painful, making it uncomfortable to move or perform everyday tasks. As your immune system works harder, your muscles may tire more quickly, leaving you feeling sluggish.
Some experience mild but persistent stiffness in arms or legs, while others report sudden heaviness that complicates climbing stairs or lifting objects. These aches and weakness can appear during any stage of the illness but are typically milder than other symptoms.
Loss of Appetite
Mononucleosis can lead to a reduced appetite, which may affect your eating habits and contribute to unintentional weight loss. You could find yourself eating less than usual or feeling uninterested in foods you normally enjoy.
Some individuals also experience fullness after only a few bites. A sore throat, fatigue, weakness, or general discomfort can further decrease food intake.
In some cases, digestive discomfort and pain may also contribute to and influence appetite changes, making it even more difficult to eat regular meals.
Skin Rash
A skin rash can occasionally occur with mononucleosis. It may be widespread or localized, appearing as small pink or red patches that can cause mild itchiness or irritation.
Some individuals describe having this rash on the chest, arms, or trunk, while others notice it appear in different body areas.
The rash can appear early or mid-way through the illness and typically fades as the body recovers. Many people experience a more pronounced rash if they take certain antibiotics while infected.
Stomach Pain
Although abdominal pain is a less common symptom of mononucleosis, you may experience it as a dull ache, cramping, or pressure in the upper left abdomen. You could also feel unusually full after small meals.
This discomfort can sometimes result from swelling in your spleen or, less commonly, your liver. The pain is usually mild to moderate, and you may notice it more when you move, bend over, take deep breaths, or after meals.
Symptoms of Serious Complications
Mononucleosis can remain contagious even after initial symptoms improve for three months or longer. During this time, a small percentage of people are at risk for serious complications, which warrant careful monitoring and medical attention.
Enlarged Spleen
You might notice fullness or heaviness in the upper left abdomen, possibly making bending or twisting uncomfortable. The area may sometimes look or feel distended, although it’s not always visible and can occasionally cause mild discomfort.
This occurs when your spleen enlarges as part of the overall immune response to the infection. While splenomegaly is uncommon, a sudden increase in pain or a sharp ache could signal a ruptured spleen, which is a serious emergency requiring immediate medical attention.
Inflamed Liver Symptoms
In rare cases of complications, a mild ache in the upper right abdomen may be an early sign of liver inflammation.
You might also notice a yellowish tint (jaundice) in your skin or the whites of your eyes, more visible under natural light.
In addition, your urine may become darker, while your stool could look lighter because an inflamed liver can affect how your body processes waste products. However, liver inflammation in mononucleosis is generally mild and tends to improve as you recover.
Breathing Difficulty
You might feel a tightness in your throat or difficulty taking a full breath, sometimes requiring deeper inhalations due to the inflammation in your throat.
Many people describe mild shortness of breath, particularly during conversation or light physical activity, occasionally prompting brief pauses to catch their breath.
While this rarely becomes severe, worsening breathing issues or significant throat swelling should be examined by medical professionals to rule out other conditions or complications.
