Serial computed tomography imaging of splenic infarction associated with Epstein-Barr virus infection

A 30-year-old previously healthy man presented with a 10-day history of fever, generalized fatigue, sore throat, and arthralgia. Physical examination revealed tender cervical lymphadenopathy and right upper abdominal discomfort on palpation. Laboratory tests showed a white blood cell count of 12,100 cells/µL with 21 % atypical lymphocytes, and elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels at 174 U/L and 339 U/L, respectively. Contrast-enhanced abdominal computed tomography (CT) performed to evaluate the abdominal discomfort revealed hepatosplenomegaly and a wedge-shaped low-attenuation area in the spleen, consistent with splenic infarction. Subsequent serologic testing was positive for Epstein-Barr virus (EBV) viral capsid antigen immunoglobulin M (IgM) and negative for Epstein-Barr nuclear antigen antibodies, confirming a diagnosis of primary EBV infection. The patient subsequently became afebrile, his symptoms resolved spontaneously, and his AST and ALT levels normalized. Follow-up CT imaging showed a slight reduction in the size of the splenic infarction at 5 weeks, and a marked reduction at 8 weeks. Splenic infarction is a rare but recognized complication of primary EBV infection. Although it generally has a favorable prognosis, careful clinical monitoring is essential due to the potential risk of splenic rupture, which may necessitate splenectomy. Some cases have been treated with anticoagulation therapy; however, most, including this patient, improve with supportive care alone. This case highlights the spontaneous healing of EBV-associated splenic infarction demonstrated through serial imaging and suggests that follow-up imaging may be unnecessary in the absence of abdominal symptoms.