Splenic infarction is a relatively uncommon diagnosis. It occurs when the splenic artery or one of its sub-branches is occluded with an infected or bland embolus or clot. Splenic infarction may be caused by atrial fibrillation, bacterial endocarditis, sickle cell disease, antiphospholipid syndrome, and trauma whereas an infectious etiology is uncommon. It is considered a rare presentation of acute infectious mononucleosis. Currently, its pathogenesis is still unclear. We describe a 24-year-old African American female who was admitted for evaluation of left-sided chest pain. Chest imaging, abdominal ultrasound, and initial laboratory data were normal, followed by a negative hypercoagulability panel. Signs and symptoms of infectious etiology were absent, however, both IgM and IgG antibodies for Ebstein-Barr virus (EBV) viral capsid antigen were high. Contrast-enhanced abdominal computed tomography revealed splenomegaly and multiple infarcts in the spleen, which eventually led to the diagnosis of infectious mononucleosis-associated splenic infarction, resolving the diagnostic dilemma.
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References with DOI
1. Antopolsky M, Hiller N, Salameh S. Splenic infarction: 10 years of experience. Am J Emerg Med 2009; 27(3):262–5. https://doi.org/10.1016/j.ajem.2008.02.014
2. Van Hal S, Senanayake S, Hardiman R. Splenic infarction due to transient antiphospholipid induced by acute Epstein-Barr virus infection. J Clin Virol 2005; 32(3):245-7. https://doi.org/10.1016/j.jcv.2004.07.013
3. Tan DC, Low AH, Ong HS. Unusual abdominal manifestations of catastrophic antiphospholipid syndrome. Br J Haematol 2006; 132(5):538. https://doi.org/10.1111/j.1365-2141.2005.05902.x
4. Symeonidis A, Papakonstantinou C, Seimeni U. Non hypoxia related splenic infarct in a patient with sickle cell trait and infectious mononucleosis. Acta Haematol 2001; 105(1):53-6. https://doi.org/10.1159/000046534
5. Beckett D, Miller C, Ferrando JR. Case report: polycythaemia vera presenting as massive splenic infarction and liquefaction. Br J Radiol 2004; 77(922):876-7. https://doi.org/10.1259/bjr/17267873
6. Suzuki Y, Shichishima T, Mukae M. Splenic infarction after Epstein- Barr virus infection in a patient with hereditary spherocytosis. Int J Hematol 2007; 85(5):380-3. https://doi.org/10.1532/ijh97.07208
7. Gavriilaki E, Sabanis N, Paschou E. Splenic infarction as a rare complication of infectious mononucleosis due to Epstein- Barr virus infection in a patient with no significant comorbidity: case report and review of the literature. Scand J Infect Dis 2013; 45(11):888–90. https://doi.org/10.3109/00365548.2013.821627
8. Gang MH, Kim JY. Splenic infarction in a child with primary Epstein-Barr virus infection. Pediatr Int 2013; 55(5):e126–8. https://doi.org/10.1111/ped.12143
9. Nores M, Phillips EH, Morgenstern L. The clinical spectrum of splenic infarction. Am Surg 1998; 64(2):182–8.
10. Jaroch MT, Broughan TA, Hermann RE. The natural history of splenic infarction. Surgery 1986; 100(4):743–50.
Urella, Madhulika; Srivastava, Roma; Ahmed, Waseem; and Lebowicz, Yehuda
"Splenic infarction: An uncommon presentation of acute infectious mononucleosis,"
Marshall Journal of Medicine:
4, Article 5.
Available at: https://mds.marshall.edu/mjm/vol2/iss4/5