Cullen's sign: it doesn't always mean hemorrhagic pancreatitis

Periumbilical ecchymosis, Cullen's sign, is most often considered a sign of hemorrhagic pancreatitis. We present a case of splenic rupture secondary to infectious mononucleosis in a middle-aged patient whose presenting complaint was the presence of Cullen's sign, secondary to the hemoperitoneum. The splenic rupture was managed conservatively, and the Cullen's sign resolved within 14 days of presentation.