Spontaneous splenic rupture resulted from infectious mononucleosis

Abstract

Spontaneous rupture of spleen secondary to IM can be lethal in those patients with high possibility of deterioration with conservative management, thus timely surgical intervention is required.

ATraumatic Splenic Rupture: Dreaded Complication of Splenomegaly

“…Epstein-Barr virus is a gamma-group herpesvirus (human herpesvirus-4) that usually causes a self-limited disease characterized by the triad of fever, generalized lymphadenopathy, and sore throat [13]. Symptomatic infection peaks at age 15-24 years and up to 30% of college students are affected each year [10].…”

“…Splenomegaly is usually most prominent in the second and third weeks of infection due to proliferation of mononuclear cells within the spleen and occurs in approximately 60% of patients. Although the overwhelming majority of these patients with splenomegaly are asymptomatic, splenic rupture occurs in 0.06-0.5% of cases and is the #1 cause of death from infectious mononucleosis [10,13]. The atypical lymphocytes that are characteristic of the disease are virus-specific cytotoxic T cells and suppressor T cells; these are enlarged cells with an increased amount of cytoplasm, vacuoles, and have indentations of the cell membrane.…”

“…Most ruptures occur by day 21 of illness and very few occur after day 28, so that return to sports should be at least four weeks from onset of illness [10]. The mechanism of rupture is thought to involve two mechanisms: 1) expanding subcapsular hematoma that eventually tears the capsule; 2) valsalva maneuver (cough, sneeze, vomit, or even turning over in bed) increasing the portal venous pressure in an already engorged spleen accompanied by forceful diaphragmatic or abdominal wall contraction causing sudden compression of the spleen [10,13].…”

“…Urgent surgical consultation is warranted when the diagnosis is confirmed or highly suspected [2]. Although there has been an increase in the successful non-operative management of hemodynamically stable patients with blunt splenic rupture, total splenectomy is still recommended for patients with pathologic splenic rupture [2,13]. Observation, angioembolization, and splenorrhaphy have unacceptable risks since the underlying process that caused the initial rupture are still present so that the chance of re bleeding is quite high.…”

Non-surgical management of spontaneous splenic rupture in infectious mononucleosis

“…The majority of patients will have asymptomatic splenomegaly, caused by the proliferation of mononuclear cells in the spleen. However, spontaneous rupture or atraumatic rupture of spleen secondary to infectious mononucleosis is rare, has an estimated incidence of 0.06% to 0.5% 3 and is the most frequent cause of death in infectious mononucleosis.…”