A surprising cause of chest pain

We present the case of a 19 years female who was referred to our institution because of severe left-sided chest pain. While the clinical picture suggested acute mononucleosis, low O2 saturation, slightly altered ECG, and pain in the left hemithorax could not be explained by an acute EBV infection. Using a CT scan, we ruled out a pulmonary embolism. However, we found two fresh splenic infarcts. Diseases of the (left) upper abdomen can cause symptoms in the left hemithorax, which explains the atypical presentation. In the rare instance of splenic infarction in acute mononucleosis, we recommend supportive treatment. However, careful observation is needed because some data suggest a potential progression to splenic rupture. Additionally, it is debatable whether NSAID--the standard treatment of acute EBV--should be avoided in this situation because it inhibits thrombocytic functions.