Spontaneous Spleen Rupture: An Unexpected Consequence of Infectious Mononucleosis - A Case Report

Abstract

A 28-year-old man, with no remarkable previous medical history, was admitted in the emergency room for fever, odynophagia and colitis-like symptoms. A blood test showed neutrophilic hyperleukocytosis. An abdominal CT scan showed splenomegaly, and rupture of the spleen which prompted a surgical procedure. A posteriori blood serology examination showed increased immunoglobulins type IgM for cytomegalovirus (CMV) and Epstein Barr virus (EBV). There was no history of previous trauma. Spontaneous spleen rupture secondary to EBV infection-associated splenomegaly is a rare medical condition. It can be life-threatening and represents a diagnostic challenge as it may sometimes occur months after the viral infection. In addition it can occur without clinical signs of hemodynamic shock. The inversion of the leukocyte formula contributes to the diagnosis. The clinical presentation, the diagnostic, and the therapeutic strategy for spontaneous splenic rupture are discussed. The prophylactic management of splenectomized patients is also discussed.