The unexpected finding of a splenic infarction in a patient with infectious mononucleosis due to Epstein-Barr virus

Abstract

SUMMARYThe 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 reevaluation 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. BACKGROUND

Splenic infarct in a patient with Infectious Mononucleosis: a rare presentation

“…Other causes revolve around the presence of a transient hypercoagulable state, caused by a decrease in the levels of protein C and protein S, compounded by an increase in the size of the spleen, resulting in an infarct [10,11]. However, activated protein C resistance was not checked [12]. A case report was also seen to have positive antiphospholipid antibodies and another with elevated factor Ⅶ [12,13].…”

“…However, activated protein C resistance was not checked [12]. A case report was also seen to have positive antiphospholipid antibodies and another with elevated factor Ⅶ [12,13]. Hence, further studies will be needed to establish the hypothesis of transient hypercoagulable state leading to splenic infarct.…”

Splenic infarction associated with acute infectious mononucleosis due to Epstein–Barr virus infection

“…Of the 19 patients, nine underwent follow-up imaging: CT in four cases [van Hal et al, 2005;Gang and Kim, 2013;Kobe et al, 2013;Li et al, 2014], US in three [Cull and Stein, 2012;Gavriilaki et al, 2013;Machado et al, 2015], MRI in one [Breuer et al, 2008], and one case did not mention the imaging method [Trevenzoli et al, 2001]. Seven patients showed improvement in a median follow-up time of 67 days (range, 30-128 days) [Trevenzoli et al, 2001;van Hal et al, 2005;Cull and Stein, 2012;Gang and Kim, 2013;Gavriilaki et al, 2013;Kobe et al, 2013;Machado et al, 2015]. However, one patient had aggravated findings on follow-up MRI after 10 days [Breuer et al, 2008], while another patient had no change on follow-up CT performed within 7 days [Li et al, 2014].…”

“…In the case presented in this study, coagulopathy test results were within the normal range. However, some cases have suggested that coagulopathy is associated with splenic infarction in IM, including a case with decreased activity of proteins C and S, but activated protein C resistance not checked [Breuer et al, 2008;Gang and Kim, 2013;Machado et al, 2015]; a case of positive lupus anticoagulant and anticardiolipin antibodies [Hunt et al, 2010;Cull and Stein, 2012]; a case of positive antiphospholipid antibodies [van Hal et al, 2005;Cull and Stein, 2012]; and a case with increased factor VIII [Machado et al, 2015]. In most cases, however, thrombophilic study results were unremarkable or not available.…”

On Epstein-Barr Virus Activation in Lymphoid and Epithelial Cancer Cells

“…Some of the active genes influence different molecular and cell cascades, in particular, the signal activity through the transcription factor NF-kB which is of particular importance for latency maintenance. A state of latency is reversible, mechanisms, causing viral genome transcription reactivation, are studied insufficiently [22,23].…”