
==== Front
Intern Med
Intern Med
Internal Medicine
0918-2918
1349-7235
The Japanese Society of Internal Medicine

38171871
10.2169/internalmedicine.2942-23
Pictures in Clinical Medicine
Splenic Infarctions in Epstein-Barr Virus Infectious Mononucleosis
Kobayashi Takahiro 1
Ono Yosuke 1
1 Department of General Medicine, National Defense Medical College, Japan
Correspondence to Dr.　Yosuke Ono, onoyousuke1979@yahoo.co.jp

2 1 2024
15 8 2024
63 16 23512352
19 9 2023
6 11 2023
Copyright © 2024 by The Japanese Society of Internal Medicine
https://creativecommons.org/licenses/by-nc-nd/4.0/ The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
splenic infarction
Epstein-Barr virus
infectious mononucleosis
==== Body
pmcA 17-year-old girl presented with a 10-day history of a fever and fatigue accompanied by worsening cough and epigastric pain. She had had sexual intercourse four weeks earlier. A physical examination revealed tender cervical lymphadenopathy, palatine petechiae, and hepatosplenomegaly. Laboratory testing revealed elevated levels of atypical lymphocytes (42.0%), hepatic transaminase, lactate dehydrogenase, and Epstein-Barr virus (EBV) capsid antigen IgM antibodies, leading to the diagnosis of EBV infectious mononucleosis. The patient tested negative for human immunodeficiency virus antibodies. Hepatosplenomegaly and multiple splenic infarctions were noted on contrast-enhanced abdominal computed tomography (Picture 1). Supportive care without anticoagulation was chosen because of her mild symptoms and lack of a hypercoagulable state (1,2). Her symptoms were alleviated, and splenic infarctions disappeared within eight weeks (Picture 2). Splenic infarction is a rare complication of infectious mononucleosis that can improve without anticoagulation unless an underlying hypercoagulable state, including malignancy, trauma, atherosclerosis, or antiphospholipid syndrome, is identified. Although blood culture examinations were not performed for the present patient because of the atypical elevated lymphocyte count and self-limiting clinical course without antibiotic treatment, these examinations should be undertaken for patients with an unknown etiology of splenic infarctions and lasting symptoms to exclude the likelihood of septic embolism. This case highlights the natural course of self-limiting splenic infarctions caused by EBV infectious mononucleosis.

Picture 1.

Picture 2.

The authors state that they have no Conflict of Interest (COI).

Financial Support

This work was supported by the Japan Medical Education Foundation (https://www.jmef.or.jp/). The funders had no role in the preparation of the manuscript or the decision to publish.
==== Refs
1. Nishioka H , Hayashi K , Shimizu H . Case report: splenic infarction in infectious mononucleosis due to Epstein-Barr virus infection. Am J Trop Med Hyg 106 : 623-625, 2021.34844205
2. 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 89 : 332-336, 2017.27357912
