title: [Spontaneous rupture of the spleen in infectious mononucleosis: case report and review of the literature].
abstract: OBJECTIVE
  Spontaneous splenic rupture is a rare but potentially fatal complication of infectious mononucleosis. Abdominal pain is uncommon in infectious mononucleosis, and splenic rupture should be strongly considered whenever abdominal pain occurs. The onset of pain may be insidious or abrupt. The pain is usually in the left upper quadrant.
  
  
  OBJECTIVE
  To indicate that infectious mononucleosis is not always the innocent kissing disease, but could be complicated with splenic rupture as a life-threathenig condition.
  
  
  METHODS
  Our first case is described and a short literature review is provided. We report on the case of a 27-year-old man with infectious mononucleosis who had spontaneous splenic rupture that was successfully managed by splenectomy. On admission, he was febrile (38.5 degrees C) with hepatosplenomegaly, and had a blood pressure of 100/70 mm Hg. Six hours later, the patient complained of increasing abdominal pain. Abdominal ultrasound and computed tomography showed a 16.5 cm heterogeneous splenomegaly with subcapsular hematoma as well as free ascites. Laparotomy confirmed spontaneous rupture of the splenic capsule with active abdominal bleeding. Splenectomy was performed with a good clinical response. Examination of the spleen revealed a ruptured capsule with a subcapsular hematoma.
  
  
  CONCLUSIONS
  Infectious mononucleosis is the most common infectious disease to result in spontaneous spleen rupture. The prognosis is favorable when diagnosis is made on time and correct treatment is started immediately. Although splenectomy was advocated as definitive therapy in the past, numerous recent reports have documented good outcomes with non-operative management. Based on the literature review, an approach to the management of a spontaneously ruptured spleen secondary to infectious mononucleosis is suggested. Non-operative management can be successful in hemodynamically stable patients, i.e. in patients with subcapsular hematoma without overt rupture of the capsule to avoid complications of splenectomy (e.g. post-splenectomy sepsis).
  
  
  CONCLUSIONS
  We report on a 27-year-old man with infectious mononucleosis who had spontaneous splenic rupture that was successfully managed by splenectomy.
authors.affiliation: Klinika za infektivne bolesti Dr. Fran Mihaljević Zagreb, Hrvatska. ikuzman@bfm.hr
authors.forename: Ilija
authors.initials: I
authors.lastname: Kuzman
authors.forename: Petar
authors.initials: P
authors.lastname: Kirac
authors.forename: Tomislav
authors.initials: T
authors.lastname: Kuzman
authors.forename: Ivan
authors.initials: I
authors.lastname: Puljiz
authors.forename: Vide
authors.initials: V
authors.lastname: Bilić
mesh_terms: D000328:Adult; D006801:Humans; D007244:Infectious Mononucleosis / Q000150:complications*; D008297:Male; D012422:Rupture, Spontaneous; D013161:Splenic Rupture / Q000209:etiology*