Spontaneous Splenic Rupture in a Case of Infectious Mononucleosis

Infectious Mononucleosis is a common viral illness mainly of adolescent-young adult age group. Spontaneous splenic rupture is a rare but potentially fatal complication of Infectious Mononucleosis occurring in less than 0.5 % of the cases. A high index of suspicion especially if abdominal pain develops during Infectious Mononucleosis is very crucial to early diagnosis and intervention in the case of rupture. Here we discuss the case of a 24 year old male with no previous comorbidities and stable vitals who presented with febrile illness of one week duration associated with abdominal discomfort. Even though initial evaluation did not point towards any etiological clues, a CT imaging of the abdomen was opted due to his persistent abdominal symptoms which showed features suggestive of a contained rupture of spleen. The lack of a specific trauma history prompted further workup for an infective etiology and patient was subsequently found to be positive for Epstein Barr Virus antigen and was diagnosed to have Infectious Mononucleosis. Rupture being of lower grades, non-operative management was opted for and patient improved with conservative management over 4-8 weeks with no further complications. We also discuss the internationally accepted grading of splenic injury and the general consensus regarding management of the same. A general search of the available literature showed very few cases of spontaneous splenic rupture in Infectious Mononucleosis being reported especially from India and hence the importance of this case.