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We report a 7-year-old boy with the clinical presentation of bilateral anterior cervical lymph node enlargement from infectious mononucleosis. Infectious mononucleosis is commonly caused by infection with the Epstein-Barr virus. Laboratory confirmation has low sensitivity with the Monospot test to detect Epstein-Barr virus heterophile antibodies. Due to the lack of consensus guidelines for the evaluation of infectious mononucleosis, health care practitioners should consider its varied clinical presentation and test accuracy.