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Singhal A, Suchman KI, Rhee A, Patel H, Paracha A, Agrawal V, Cohen J. Splenic Infarction Due to Epstein-Barr Virus: A Case Report and Literature Review. Cureus 2024; 16:e58414. [PMID: 38756285 PMCID: PMC11098526 DOI: 10.7759/cureus.58414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Splenic infarction is a rare and likely underdiagnosed complication of Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM). Here, we describe an 18-year-old Guyanese male with persistent severe left-sided abdominal pain found to be EBV positive and have a large splenic infarct, along with a transient decrease in protein C, protein S, and antithrombin III activity levels. He was treated with supportive care and anticoagulated with heparin and apixaban. We review prior reports and perspectives on underlying pathophysiology, diagnosis, and the management of these cases, which likely do not require anticoagulation but may be considered on a per-case basis.
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Affiliation(s)
- Adit Singhal
- Internal Medicine, Northwell Health, New Hyde Park, USA
| | | | - Aaron Rhee
- Internal Medicine, Northwell Health, New Hyde Park, USA
- Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Himanshu Patel
- Internal Medicine, Northwell Health, New Hyde Park, USA
- Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Awais Paracha
- Internal Medicine, Northwell Health, New Hyde Park, USA
| | - Vedika Agrawal
- Pediatrics, Ohio State University, Nationwide Children's Hospital, Columbus, USA
| | - Jessica Cohen
- Internal Medicine, Northwell Health, New Hyde Park, USA
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2
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Kobayashi K, Kishi Y, Serizawa Y, Kimizuka Y, Ueno H. Splenic Infarction Associated With Epstein-Barr Virus in an Adult With an Anatomic Anomaly: A Case Report. Cureus 2023; 15:e40530. [PMID: 37461773 PMCID: PMC10350304 DOI: 10.7759/cureus.40530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
Splenic infarction (SI) is often associated with circulatory and hematological diseases and infections. Here, we report a rare case of SI in an adult with infectious mononucleosis (IM) caused by the Epstein-Barr (EB) virus. A 31-year-old male with an unremarkable medical history presented with abdominal pain and fever. Contrast-enhanced computed tomography revealed focal SI. The splenic artery branching from the superior mesenteric artery was <5 mm in diameter. The diagnosis of EB virus infection was made based on physical examination and blood test results. As no evidence of cardiogenic disease, malignant lymphoma, or other infections were present, a diagnosis of SI associated with IM was made. A symptomatic treatment was administered, and the splenomegaly and SI improved two weeks after discharge. IM was assumed as the cause of the focal SI.
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Affiliation(s)
| | - Yoji Kishi
- Surgery, National Defence Medical College, Tokorozawa, JPN
| | - Yusuke Serizawa
- Internal Medicine, National Defence Medical College, Tokorozawa, JPN
| | | | - Hideki Ueno
- Surgery, National Defence Medical College, Tokorozawa, JPN
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Toti JMA, Gatti B, Hunjan I, Kottanattu L, Faré PB, Renzi S, Bianchetti MG, Milani GP, Lava SAG, Camozzi P. Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: a systematic literature review. Swiss Med Wkly 2023; 153:40081. [PMID: 37245117 DOI: 10.57187/smw.2023.40081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Epstein-Barr virus (EBV), also known as human herpesvirus 4, is one of the most common pathogenic viruses in humans. EBV mononucleosis always involves the spleen and as such it predisposes to splenic rupture, often without a trauma, and splenic infarction. Nowadays the goal of management is to preserve the spleen, thereby eliminating the risk of post-splenectomy infections. METHODS To characterise these complications and their management, we performed a systematic review (PROSPERO CRD42022370268) following PRISMA guidelines in three databases: Excerpta Medica, the United States National Library of Medicine, and Web of Science. Articles listed in Google Scholar were also considered. Eligible articles were those describing splenic rupture or infarction in subjects with Epstein-Barr virus mononucleosis. RESULTS In the literature, we found 171 articles published since 1970, documenting 186 cases with splenic rupture and 29 with infarction. Both conditions predominantly occurred in males, 60% and 70% respectively. Splenic rupture was preceded by a trauma in 17 (9.1%) cases. Approximately 80% (n = 139) of cases occurred within three weeks of the onset of mononucleosis symptoms. A correlation was found between the World Society of Emergency Surgery splenic rupture score, which was retrospectively calculated, and surgical management: splenectomy in 84% (n = 44) of cases with a severe score and in 58% (n = 70) of cases with a moderate or minor score (p = 0.001). The mortality rate of splenic rupture was 4.8% (n = 9). In splenic infarction, an underlying haematological condition was observed in 21% (n = 6) of cases. The treatment of splenic infarction was always conservative without any fatal outcomes. CONCLUSIONS Similarly to traumatic splenic rupture, splenic preservation is increasingly common in the management of mononucleosis-associated cases as well. This complication is still occasionally fatal. Splenic infarction often occurs in subjects with a pre-existing haematological condition.
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Affiliation(s)
- Johannes M A Toti
- Department of Surgery and Transplantation, University Hospital Zurich Zurich, Switzerland
| | - Beatrice Gatti
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Isabella Hunjan
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Lisa Kottanattu
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pietro B Faré
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Samuele Renzi
- Division of Hematology and Oncology, CHUL-Laval, Quebec City, Canada
- Department of Pediatrics, Laval University, Quebec City, Canada
| | - Mario G Bianchetti
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Heart Failure and Transplantation, Department of Pediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
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Mamo G, Erickson S, Komanduri K, Zayas D, Aggarwal N. Infectious Mononucleosis-Induced Splenic Infarction: Perhaps More Common in Healthy Individuals Than Previously Thought. Cureus 2023; 15:e39472. [PMID: 37378159 PMCID: PMC10292093 DOI: 10.7759/cureus.39472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Infectious mononucleosis (IM) is a clinical syndrome that presents as a triad of fever, pharyngitis, and lymphadenopathy. In most cases, it is caused by the Epstein-Barr virus (EBV), which spreads through upper respiratory secretions, particularly saliva, earning its name as the Kissing Disease. In most cases, IM is self-limiting and resolves in two to four weeks without significant sequelae following supportive care. Although rare, IM has been associated with several serious and sometimes life-threatening complications, involving almost any organ system. Splenic infarction is one rare complication of IM due to EBV infection. In the past, IM-induced splenic infarction in the setting of EBV was believed to be rare and mostly limited to patients with underlying hematologic comorbidities. However, we propose this condition to be more common and more likely to occur in individuals without significant medical history than previously suspected. We report a relatively healthy young male patient in his thirties, with no previous history of coagulopathy or complex medical conditions, who was found to have IM-induced splenic infarction.
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Affiliation(s)
- Gabriella Mamo
- Internal Medicine, HCA Florida Ocala Hospital, Ocala, USA
| | - Stephanie Erickson
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | | - Dewid Zayas
- Internal Medicine, HCA Florida Ocala Hospital, Ocala, USA
| | - Niti Aggarwal
- Internal Medicine, HCA Florida Ocala Hospital, Ocala, USA
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5
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Ma Z, Wang Z, Zhang X, Yu H. Splenic infarction after Epstein–Barr virus infection in a patient with hereditary spherocytosis: a case report and literature review. BMC Surg 2022; 22:136. [PMID: 35397569 PMCID: PMC8994260 DOI: 10.1186/s12893-022-01580-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hereditary spherocytosis (HS) complicated by splenic infarction is very rare, and it is even rarer to develop splenic infarction after infectious mononucleosis (IM) as a result of Epstein–Barr virus (EBV) infection. Therefore, misdiagnosis or missed diagnosis is prone to occur.
Case presentation
A 19-year-old Chinese female previously diagnosed with HS was admitted to our institution with persistent high fever and icterus. On admission, the physical examination showed anemia, jaundice, marked splenomegaly, obvious tenderness in the left upper abdomen (LUA). Peripheral blood film shows that spherical red blood cells accounted for about 6%, and Immunoglobulin M (IgM) antibodies specific to Epstein–Barr virus (EBV) viral capsid antigen were detected. An abdominal CT scan revealed a splenic infarction. The patient was diagnosed with HS with splenic infarction following EBV infection and underwent an emergency laparoscopic splenectomy (LS). Pathological analysis showed a splenic infarction with red pulp expansion, white pulp atrophy and a splenic sinus filled with red blood cells. After two months of follow-up visits, the patient showed no signs of relapse.
Conclusions
HS complicated by splenic infarction is very rare and mostly occurs in men under 20 years of age and is often accompanied by other diseases, such as sickle cell traits (SCT) or IM. Although symptomatic management may be sufficient, emergency laparoscopic splenectomy may be safe and effective when conservative treatment is ineffective.
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6
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Thida AM, Ilonzo I, Gohari P. Multiple splenic infarcts: unusual presentation of hereditary spherocytosis associated with acute Epstein-Barr virus infection. BMJ Case Rep 2020; 13:13/7/e235131. [PMID: 32665280 DOI: 10.1136/bcr-2020-235131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 19-year-old African American woman presented to the emergency department with a history of left upper quadrant pain for a week, associated with nausea, malaise, loss of appetite, subjective fevers and chills. Her family history is significant for thalassemia in her maternal aunt, and hereditary spherocytosis in her brother, sister and cousin. A contrast-enhanced CT scan of the abdomen and pelvis revealed massive splenomegaly and multiple splenic infarcts. On the second day of admission, she developed a fever of 103°F. Further evaluation revealed acute Epstein-Barr virus (EBV) infection and hereditary spherocytosis. Her condition improved after 4 days on piperacillin/tazobactam, intravenous fluids, analgesics and antipyretics. Our case report describes a thorough clinical evaluation of a patient with fever, anaemia, massive splenomegaly and multiple splenic infarcts. It highlights the need for careful interpretation of multiple positive IgM results on viral serological testing that often accompanies acute EBV infections.
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Affiliation(s)
- Aye Mon Thida
- Department of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| | - Ifeanyi Ilonzo
- Department of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| | - Pouyan Gohari
- Hematology and Oncology Department, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
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7
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Nofal R, Zeinali L, Sawaf H. Splenic infarction induced by epstein-barr virus infection in a patient with sickle cell trait. J Paediatr Child Health 2019; 55:249-251. [PMID: 30746887 DOI: 10.1111/jpc.14376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/18/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Rofida Nofal
- Department of Pediatric Hematology Oncology, UCSF Benioff Children's Hospital, Oakland, California, United States
| | - Lida Zeinali
- Department of Pediatrics, Oishei Children's Hospital, University at Buffalo, Buffalo, New York, United States
| | - Hadi Sawaf
- Department of Pediatrics, Van Eslander Cancer Centre, Grosse Pointe Woods, Michigan, United States
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8
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Di Serafino M, Verde F, Ferro F, Vezzali N, Rossi E, Acampora C, Valente I, Pelliccia P, Speca S, Vallone G. Ultrasonography of the pediatric spleen: a pictorial essay. J Ultrasound 2018; 22:503-512. [PMID: 30446947 DOI: 10.1007/s40477-018-0341-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/09/2018] [Indexed: 12/26/2022] Open
Abstract
In infants and children, the spleen is involved in many pathological processes, whether those processes are isolated or related to systemic diseases. Pathology of the pediatric spleen includes congenital anomalies, splenomegaly, trauma, focal lesions, infarction, and tumors. Ultrasonography (US) is a widely available, fast, noninvasive imaging technique to assess the size, shape, and position of the spleen, as well as to define splenic echotexture. US is capable of screening for splenic disorders without the risk of ionizing radiation; it is the initial imaging examination performed to evaluate suspected splenic pathology, providing clinicians with helpful decisional support. US plays an important role in the detection of even very small amounts of hemoperitoneum, a herald of significant abdominal organ injury, in pediatric blunt abdominal trauma. Moreover, contrast-enhanced US may allow early detection of splenic injuries, ideally minimizing children's risk from radiation exposure. This pictorial essay illustrates the normal ultrasound appearance of the pediatric spleen and the sonographic findings which may guide clinicians to a correct diagnosis of pathologic conditions.
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Affiliation(s)
| | - Francesco Verde
- Paediatric Radiology Department, "Federico II" University Hospital, Naples, Italy.
| | - Federica Ferro
- Radiology Department, Regional Hospital of Bolzano, Bolzano, Italy
| | - Norberto Vezzali
- Radiology Department, Regional Hospital of Bolzano, Bolzano, Italy
| | - Eugenio Rossi
- Radiology Department, "Santobono-Pausilipon" Children Hospital, Naples, Italy
| | - Ciro Acampora
- Radiology Department, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Iacopo Valente
- Radiology and Neuroradiology Imaging Diagnostic Department, Agostino Gemelli" University Hospital, IRCCS, Rome, Italy
| | | | - Stefania Speca
- Department of Radiology, Sacro Cuore" University Hospital, Rome, Italy
| | - Gianfranco Vallone
- Paediatric Radiology Department, "Federico II" University Hospital, Naples, Italy
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9
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García-Vázquez J, Plácido Paias R, Portillo Márquez M. Infarto esplénico debido a una infección común. Enferm Infecc Microbiol Clin 2018; 36:593-595. [DOI: 10.1016/j.eimc.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/24/2017] [Accepted: 09/04/2017] [Indexed: 11/15/2022]
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10
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Noor M, Sadough M, Chan S, Singh G. Splenic infarct in a patient with Infectious Mononucleosis: a rare presentation. J Community Hosp Intern Med Perspect 2017; 7:248-250. [PMID: 29046754 PMCID: PMC5637648 DOI: 10.1080/20009666.2017.1361291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/20/2017] [Indexed: 12/26/2022] Open
Abstract
We report a case of a 25-year-old obese, currently smoking, female diagnosed with EBV infectious mononucleosis. The patient complained of sudden onset abdominal pain with progressively increasing intensity in the left upper quadrant. Abdominal CT scan showed a wedge infarct of the spleen. We present this rare case that EBV may cause splenic infarct in young adults.
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Affiliation(s)
- Mustafa Noor
- Internal Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Maryam Sadough
- Internal Medicine, Babol University of Medical Science, Baltimore, MD, USA
| | - Stephanie Chan
- Internal Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
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11
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Heo DH, Baek DY, Oh SM, Hwang JH, Lee CS, Hwang JH. Splenic infarction associated with acute infectious mononucleosis due to Epstein-Barr virus infection. J Med Virol 2016; 89:332-336. [PMID: 27357912 DOI: 10.1002/jmv.24618] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to report a case of a previously healthy 20-year-old woman diagnosed with splenic infarction following infectious mononucleosis (IM) by Epstein-Barr virus (EBV) infection and to perform the first systematic review of the clinical characteristics of splenic infarction associated with IM. A systematic review was conducted using English, French, and Japanese literatures of splenic infarction associated with IM due to EBV infection published between 1961 and 2015 in PubMed Medline. A total of 19 cases were extracted from the collected articles. Left upper quadrant (LUQ) pain was observed in 15 (79%) patients. Splenectomy was performed in five (26%) cases, among which four patients presented with stable vital signs. Splenic rupture was accompanied in two (10%) patients. The median time from the onset of IM symptoms to the diagnosis of splenic infarction was 5 days (range, 1-25 days). Fourteen (74%) of 19 patients experienced improvement through medical treatment, and there were no deaths. Splenic infarction associated with IM due to EBV infection can show a favorable clinical outcome after medical treatment. Clinicians should consider the possibility of splenic infarction when patients with IM experience LUQ pain. J. Med. Virol. 89:332-336, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Dae-Hyuk Heo
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Dae-Youb Baek
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sang-Min Oh
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Joo-Hee Hwang
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Chonbuk National University Hospital, Jeonju, Republic of Korea
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12
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Splenic Infarction in Acute Infectious Mononucleosis. J Emerg Med 2015; 50:e11-3. [PMID: 26602427 DOI: 10.1016/j.jemermed.2015.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 08/24/2015] [Accepted: 09/16/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The evaluation of a febrile patient with acute abdominal pain represents a frequent yet possibly challenging situation in the emergency department (ED). Splenic infarction is an uncommon complication of infectious mononucleosis, and may have a wide range of clinical presentations, from dramatic to more subtle. Its pathogenesis is still incompletely understood, yet it may be associated with the occurrence of transient prothrombotic factors. CASE REPORT We report the case of a 14-year-old boy who presented with fever, sore throat, left upper quadrant abdominal pain, and splenomegaly, with no history of recent trauma. Laboratory tests revealed a markedly prolonged activated partial thromboplastin time and positive lupus anticoagulant. Abdominal ultrasonography showed several hypoechoic areas in the spleen consistent with multiple infarctions. Magnetic resonance imaging eventually confirmed the diagnosis. He was admitted for observation and supportive treatment, and was discharged in good condition after 7 days. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous splenic infarction should be considered in the differential list of patients presenting with left upper quadrant abdominal pain and features of infectious mononucleosis; the diagnosis, however, may not be straightforward, as clinical presentation may also be subtle, and abdominal ultrasonography, which is often used as a first-line imaging modality in pediatric EDs, has low sensitivity in this scenario and may easily miss it. Furthermore, although treatment is mainly supportive, close observation for possible complications is necessary.
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13
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Machado C, Melo Salgado J, Monjardino L. The unexpected finding of a splenic infarction in a patient with infectious mononucleosis due to Epstein-Barr virus. BMJ Case Rep 2015; 2015:bcr-2015-212428. [PMID: 26607191 DOI: 10.1136/bcr-2015-212428] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present a case of a 24-year-old man with infectious mononucleosis (IM) due to Epstein-Barr virus (EBV). Among his symptoms, he reported abdominal pain in the upper left quadrant. An abdominal ultrasound and CT revealed an extensive splenic infarction. During the acute stage of this disease, the thrombophilic screening revealed reduced free protein S and elevated factor VIII, with normalisation on re-evaluation 6 weeks later. Splenic infarction is a very rare complication of IM due to EBV but should be considered in patients presenting abdominal pain. A hypercoagulability state should be investigated. To our knowledge, this is the first described case of a splenic infarction in a patient with IM due to EBV associated with a transient reduction of protein S and elevation of factor VIII. Thus, this work promotes the importance of including these factors in the thrombophilic screening conducted during the investigation of similar cases.
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Affiliation(s)
- Catarina Machado
- Department of Internal Medicine, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, Portugal
| | - Joana Melo Salgado
- Unidade de Saúde da Ilha Terceira-Centro de Saúde de Angra do Heroísmo, Angra do Heroísmo, Portugal
| | - Leonor Monjardino
- Department of Internal Medicine, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, Portugal
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14
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Jones L, Refai Z, Linney M. An adolescent with hereditary spherocytosis who presented with splenic infarction. BMJ Case Rep 2015; 2015:bcr-2014-206196. [PMID: 26139647 DOI: 10.1136/bcr-2014-206196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 16-year-old male patient with known hereditary spherocytosis presented with a 4-day history of chest pain and lethargy. On admission, he had a low-grade fever and was grossly anaemic; examination revealed splenomegaly. An ultrasound scan confirmed splenomegaly with areas of splenic infarction. Subsequent tests suggested possible Epstein-Barr virus infection. The patient recovered well and had a functional spleen on discharge. This case report presents an unusual complication of isolated hereditary spherocytosis.
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Affiliation(s)
- Lara Jones
- Department of Paediatrics, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - Zafer Refai
- Department of Paediatrics, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - Mike Linney
- Department of Paediatrics, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
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15
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Gang MH, Kim JY. Splenic infarction in a child with primary Epstein-Barr virus infection. Pediatr Int 2013; 55:e126-8. [PMID: 24134766 DOI: 10.1111/ped.12143] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/12/2013] [Accepted: 05/20/2013] [Indexed: 11/26/2022]
Abstract
Described herein is the case of a previously healthy 7-year-old girl who had splenic infarction. This lesion was identified 1 day after the first presentation of peri-umbilical and right upper quadrant pain. She had abnormal hepatic function and mild splenomegaly, and was diagnosed as having primary Epstein-Barr virus (EBV) infection. Coagulation profiles indicated low plasma activity of protein C (49%) and protein S (47%), which normalized 3 weeks later. Hypercoagulability in transient protein C and protein S deficiency might contribute to the development of splenic infarction in infectious mononucleosis.
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Affiliation(s)
- Mi Hyeon Gang
- Department of Pediatrics, School of Medicine, Chungnam National University, Daejeon, Korea
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16
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Gavriilaki E, Sabanis N, Paschou E, Grigoriadis S, Mainou M, Gaitanaki A, Skargani-Koraka M. 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. ACTA ACUST UNITED AC 2013; 45:888-90. [PMID: 23957538 DOI: 10.3109/00365548.2013.821627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report the case of a 17-y-old boy diagnosed with infectious mononucleosis due to Epstein-Barr virus infection who complained of left upper quadrant pain. A magnetic resonance imaging scan showed a splenic infarct in the enlarged spleen. Other causes of splenic infarction were excluded. Thus, infectious mononucleosis may cause splenic infarction in patients without other comorbidities.
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Affiliation(s)
- Eleni Gavriilaki
- From the Department of Internal Medicine, General Hospital of Edessa , Edessa , Greece
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17
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Hedgire SS, Sainani NI, McDermott S, Hahn PF, Harisinghani MG. Mono-belly and beyond: spectrum of imaging manifestations of EBV infection in the abdomen. Clin Imaging 2013; 37:711-7. [PMID: 23317894 DOI: 10.1016/j.clinimag.2012.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 10/12/2012] [Accepted: 10/22/2012] [Indexed: 11/27/2022]
Abstract
Epstein-Barr virus (EBV) is a DNA virus from the herpes virus group affecting only humans. More than 90% adults are infected by the virus, but very few ever have symptoms. Within the abdomen, both solid and hollow viscera can be involved in symptomatic disease. Awareness of the spectrum of imaging findings, high index of suspicion, and appropriate clinical and laboratory information can help in the early and accurate diagnosis in these cases.
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Affiliation(s)
- Sandeep S Hedgire
- Department of abdominal Imaging and Intervention, Massachusetts General Hospital, Boston, MA 02114, USA.
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Cull E, Stein BL. Splenic infarction, warm autoimmune hemolytic anemia and antiphospholipid antibodies in a patient with infectious mononucleosis. Int J Hematol 2012; 95:573-6. [PMID: 22407854 DOI: 10.1007/s12185-012-1047-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/27/2012] [Accepted: 02/28/2012] [Indexed: 02/04/2023]
Abstract
An 18-year-old woman with infectious mononucleosis developed splenic infarction and severe anemia. Evaluation of her anemia revealed a warm autoantibody and a persistently prolonged partial thromboplastin time that ultimately led to the identification of antiphospholipid antibodies. Although the warm autoantibody disappeared after 2 months, the antiphospholipid antibodies remained persistently positive. To our knowledge, this is the first case report in the literature of this specific constellation of findings, with infectious mononucleosis, warm antibody hemolytic anemia, splenic infarction and persistently positive, high-titer antiphospholipid antibodies occurring in an individual patient.
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Affiliation(s)
- Elizabeth Cull
- Division of Hematology/Oncology, Department of Medicine, Feinberg School of Medicine and Northwestern Memorial Hospital, Northwestern University, Chicago, IL 60611, USA
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Park MY, Kim JA, Yi SY, Chang SH, Um TH, Lee HR. Splenic infarction in a patient with autoimmune hemolytic anemia and protein C deficiency. THE KOREAN JOURNAL OF HEMATOLOGY 2012; 46:274-8. [PMID: 22259634 PMCID: PMC3259520 DOI: 10.5045/kjh.2011.46.4.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 10/04/2011] [Accepted: 11/14/2011] [Indexed: 11/17/2022]
Abstract
Splenic infarction is most commonly caused by cardiovascular thromboembolism; however, splenic infarction can also occur in hematologic diseases, including sickle cell disease, hereditary spherocytosis, chronic myeloproliferative disease, leukemia, and lymphoma. Although 10% of splenic infarction is caused by hematologic diseases, it seldom accompanies autoimmune hemolytic anemia (AIHA). We report a case of a 47-year-old woman with iron deficiency anemia who presented with pain in the left upper abdominal quadrant, and was diagnosed with AIHA and splenic infarction. Protein C activity and antigen decreased to 44.0% (60-140%) and 42.0% (65-140%), respectively. Laboratory testing confirmed no clinical cause for protein C deficiency, such as disseminated intravascular coagulation, sepsis, hepatic dysfunction, or acute respiratory distress syndrome. Protein C deficiency with splenic infarction has been reported in patients with viral infection, hereditary spherocytosis, and leukemia. This is a rare case of splenic infarction and transient protein C deficiency in a patient with AIHA.
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Affiliation(s)
- Min Yong Park
- Division of Hematology/Oncology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
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Hunt DP, Thabet A, Rosenberg ES. Case records of the Massachusetts General Hospital. Case 29-2010. A 29-year-old woman with fever and abdominal pain. N Engl J Med 2010; 363:1266-74. [PMID: 20860509 DOI: 10.1056/nejmcpc1007084] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Daniel P Hunt
- Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, USA
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Schilling RF. Risks and benefits of splenectomyversusno splenectomy for hereditary spherocytosis - a personal view. Br J Haematol 2009; 145:728-32. [DOI: 10.1111/j.1365-2141.2009.07694.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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