Spontaneous Splenic Rupture

Context:Infectious mononucleosis is a disease primarily of adolescence and early adulthood. The risk of splenic injury and chronic fatigue make return-to-play decisions a challenge for the clinician caring for athletes with infectious mononucleosis.Evidence Acquisition:Data were obtained from the PubMed and MEDLINE databases through December 2012 by searching for epidemiology, diagnosis, clinical manifestations, management, and the role of the spleen in infectious mononucleosis.Study Design:Clinical review.Level of Evidence:Level 4.Results:Infectious mononucleosis is commonly encountered in young athletes. Its disease pattern is variable and can affect multiple organ systems. Supportive care is the cornerstone, with little role for medications such as corticosteroids. Physical examination is unreliable for the spleen, and ultrasound imaging has limitations in its ability to guide return-to-play decisions. Exercise does not appear to place the young athlete at risk for chronic fatigue, but determining who is at risk for persistent symptoms is a challenge.Conclusion:Return-to-play decisions for the athlete with infectious mononucleosis need to be individualized because of the variable disease course and lack of evidence-based guidelines.

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“…27 However, approximately 90% of patients have mildly elevated liver enzymes facilitating in the diagnosis of IM. 36 …”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…21,26,43 The athlete should engage in very light activity at first (walking), with a gradual progression to light aerobic activity. 33,36,45 Although it may take 2 to 3 months for the athlete to fully recover from IM, it appears they can initiate activity well before. 1,34,43,46 …”

Section: Return-to-play Considerationsmentioning

confidence: 99%

Return to Play After Infectious Mononucleosis

Becker

Smith

2014

Sports Health: A Multidisciplinary Approach

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“…Splenic rupture is more commonly associated with other herpesviridae, notably in glandular fever (infectious mononucleosis) caused by Epstein-Barr virus (EBV), where it complicates 0.1–0.5% of cases [ 3 ], and is typically seen in young adults, most frequently men. Splenomegaly and capsular thinning increases the risk of rupture, which may be due to minimal trauma, or occur spontaneously [ 4 ]. Other causes of non-traumatic spontaneous splenic rupture include haematological abnormalities such as lymphoma and myelofibrosis, amyloidosis, and other infections including malaria.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous splenic rupture complicating primary varicella zoster infection: a case report

Uthayakumar

Harrington

2018

BMC Res Notes

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BackgroundPrimary varicella zoster virus (VZV) infection is a common illness, predominantly affecting children. Its course is typically benign, although severe complications have been described. Splenic rupture is an extremely rare and potentially fatal complication of primary VZV infection, with only a handful of cases reported in the literature.Case PresentationA 32-year-old Romanian man with no significant past medical history, presented with a 2 day history of sudden onset, worsening generalised abdominal pain and a 1 day history of vomiting. The following day he developed fevers and a generalised widespread erythematous rash consisting of clusters of macules, papules and vesicles at different stages of development. There was no history of sore throat, coryza, arthralgia, myalgia, cough, shortness of breath, weight loss, or night sweats. There was no recent illness and no history of trauma. CT abdomen showed splenic rupture with intra-abdominal haemorrhage. Admission bloods showed anaemia and thrombocytopenia, with haemoglobin 110 g/l and platelets 78 × 109/l. Viral PCR of vesicle fluid from the rash was positive for VZV DNA confirming the clinical diagnosis of primary varicella zoster infection. Viral serology also confirmed recent infection. He was haemodynamically resuscitated, and underwent laparotomy and splenectomy. He was commenced on IV acyclovir and completed a 5 day course. Prior to discharge he was commenced on recommended splenectomy secondary prevention treatment.ConclusionThere are several reported complications of varicella infection, more commonly in the immunocompromised population. Spontaneous splenic rupture is an unusual complication of primary VZV infection. Here we report the sixth known case in the literature. Splenic rupture should be considered in cases of primary varicella in young adults presenting with abdominal pain.

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“…The treatment of choice of spontaneous splenic rupture accompanied with malaria has traditionally been splenectomy [8]; however, due to recent advances in surgical techniques and conservative treatment, as well as studies in postoperative risks of splenectomy, it is now more common to apply conservative treatment in the setting of stable vital signs and lack of progression of hemorrhage [4,8,9]. In specific malaria-endemic regions, malaria occurring after splenectomy can be fatal, which requires continued prophylactic treatment, and there are possibilities of latent malaria following the operation, which does warrant surgical treatment [9].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous splenic rupture inPlasmodium vivaxmalaria

2014

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Malaria can present with various clinical symptoms and complications. While a tertian malaria form that is especially prevalent in Korea is characterized by mild clinical progression, occasional splenic complications are known to occur. A 26-year-old Korean male soldier without prior medical history visited The Armed Forces Capital Hospital with left upper quadrant abdominal pain one day ago. Hemostasis under laparoscopic approach was attempted. The operation was converted into laparotomy due to friable splenic tissue and consequently poor hemostasis. Splenectomy was performed. The patient was discharged at postoperative day 17 without complication. While numerous diseases can result in splenic complications, such as splenic rupture, malarial infection is known as the most common cause. The incidence of malarial infection in Korea is increasing annually, and there are occasional reports of splenic rupture due to the infection, which requires attention.

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Spontaneous Splenic Rupture

Cited by 33 publications

References 20 publications

Return to Play After Infectious Mononucleosis

Return to Play After Infectious Mononucleosis

Spontaneous splenic rupture complicating primary varicella zoster infection: a case report

Spontaneous splenic rupture inPlasmodium vivaxmalaria

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