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Published on: September 7, 2022
Splenic rupture in infectious mononucleosis: A systematic review of published case reports
A Bartlett1, R Williams2, M Hilton3
1Core Surgical Trainee, ENT Department, Plymouth Hospitals NHS Trust, United Kingdom.
Introduction:
Infectious mononucleosis (IM) is a common viral illness that predominantly causes sore throat, fever and cervical lymphadenopathy in adolescents and young adults. Although usually a benign, self-limiting disease, it is associated with a small risk of splenic rupture, which can be life-threatening. It is common practice therefore to advise avoiding vigorous physical activity for at least 4-6 weeks, however this is not based on controlled trials or national guidelines. We reviewed published case reports of splenic rupture occurring in the context of IM in an attempt to ascertain common factors that may predict who is at risk.
Method:
A search of MEDLINE and EMBASE databases was performed for case reports or series published between 1984 and 2014. In total, 52 articles or abstracts reported 85 cases. Data was extracted and compiled into a Microsoft Excel(®) spreadsheet.
Results:
The average patient age was 22 years, the majority (70%) being male. The average time between onset of IM symptoms and splenic rupture was 14 days, with a range up to 8 weeks. There was a preceding history of trauma reported in only 14%. Abdominal pain was the commonest presenting complaint of splenic rupture, being present in 88%. 32% were successfully managed non-operatively, whereas 67% underwent splenectomy. Overall mortality was 9%.
Conclusions And Recommendations:
From our data, it appears that men under 30 within 4 weeks of symptom onset are at highest risk of splenic rupture, therefore particular vigilance in this group is required. As cases have occurred up to 8 weeks after the onset of illness, we would recommend avoidance of sports, heavy lifting and vigorous activity for 8 weeks. Should the patient wish to return to high risk activities prior to this, an USS should be performed to ensure resolution of splenomegaly. The majority of cases reviewed had no preceding trauma, although previous studies have suggested this may be so minor as to go unnoticed by the patient. It is therefore prudent to warn patients about the symptoms of splenic rupture to ensure prompt presentation and minimise treatment delay rather than focusing purely on activity limitation.
Insights
Infectious mononucleosis (IM) can lead to splenic rupture, a serious complication. Men under 30 are at higher risk, necessitating 8 weeks of activity restriction and prompt recognition of symptoms.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Emergency Medicine
Background:
- Infectious mononucleosis (IM) is a common viral illness in adolescents and young adults.
- While typically self-limiting, IM carries a small risk of life-threatening splenic rupture.
- Current advice on activity restriction post-IM lacks evidence-based guidelines.
Purpose of the Study:
- To review case reports of splenic rupture in patients with IM.
- To identify common factors predicting risk for splenic rupture.
- To inform evidence-based recommendations for activity restriction and patient management.
Main Methods:
- A systematic search of MEDLINE and EMBASE databases was conducted for case reports from 1984-2014.
- 85 cases reported in 52 articles were compiled and analyzed.
- Data extraction included patient demographics, symptom onset, rupture details, and management outcomes.
Main Results:
- The average patient was 22 years old, with 70% being male.
- Splenic rupture occurred an average of 14 days (up to 8 weeks) after IM symptom onset.
- Abdominal pain was the most common symptom (88%); only 14% reported preceding trauma.
Conclusions:
- Men under 30 within 4 weeks of IM symptom onset are at highest risk.
- Activity avoidance for 8 weeks is recommended, with ultrasound to assess splenomegaly for earlier return to activity.
- Patients should be educated on splenic rupture symptoms for prompt presentation, regardless of trauma history.
