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Infective splenic rupture presenting with symptoms of a pulmonary embolism

M Shah1, S Muquit, B Azam

  • 1Newham University Hospital, London E13 8SL, UK. mushtaqshah@googlemail.com

Emergency Medicine Journal : EMJ
|November 27, 2008
PubMed

Insights

Splenic rupture is a rare complication of infectious mononucleosis. This case highlights the importance of considering Epstein-Barr virus in patients presenting with abdominal pain and an enlarged spleen.

Area of Science:

  • Medicine
  • Virology
  • Surgery

Background:

  • Infectious mononucleosis, caused by the Epstein-Barr virus (EBV), commonly presents with fever, pharyngitis, and lymphadenopathy.
  • Splenic involvement, including splenomegaly, is a known complication of infectious mononucleosis.
  • Splenic rupture is an uncommon but potentially life-threatening event associated with infectious mononucleosis.

Observation:

  • A male patient presented with sudden onset pleuritic left chest pain.
  • Abdominal ultrasound revealed an enlarged spleen with an abnormal echo pattern.
  • Abdominal CT scan demonstrated severe splenic rupture.

Findings:

  • The patient reported a history of flu-like symptoms and enlarged cervical lymph nodes two weeks prior.
  • Serological tests confirmed Epstein-Barr virus infection.
  • The diagnosis was established as splenic rupture secondary to splenomegaly from infectious mononucleosis.

Implications:

  • Initial conservative management was unsuccessful due to hemodynamic instability.
  • An emergency splenectomy was required to manage the severe splenic rupture.
  • This case underscores the critical need for prompt diagnosis and management of splenic complications in infectious mononucleosis.

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