Hemorrhagic Kiss: Spontaneous Tonsillar Bleeding in Infectious Mononucleosis – Report of 2 Clinical Cases

Abstract

Spontaneous tonsillar hemorrhage is a rare but potentially life-threatening complication of infectious mononucleosis caused by Epstein-Barr virus (EBV). Early recognition and appropriate management are crucial to prevent morbidity and mortality. 2 clinical cases of spontaneous tonsillar hemorrhage associated with EBV infection was reported. A litera-ture review was performed to contextualize findings and discuss therapeutic approaches. Both cases involved young adults at 19 and 20 years old and presented with oropha-ryngeal bleeding refractory to topical hemostasis. Both patients required emergency tonsillectomy, corticosteroids, supportive care, and recovered uneventfully. Literature review identified fewer than 20 previously reported cases. Most were managed conser-vatively, though surgical intervention was necessary in refractory or severe presentations. Spontaneous tonsillar hemorrhage in infectious mononucleosis is rare but may lead to air-way compromise and significant blood loss. Conservative measures are the first line and can be effective in selected cases; however, surgical intervention should not be delayed in unstable or refractory patients.

Cite this article as: Dias JI, Dias DR, Costa SV, Carvalho R, Castro SSE, Lino J. Hemorrhagic kiss: spontaneous tonsillar bleeding in infectious mononucleosis – report of 2 clinical cases. Balkan ORL-HNS. 2026, 3, 0117, 10.5152/bohns.2026.25117.