title: Splenic Infarction in Acute Infectious Mononucleosis.
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.
  
  
  METHODS
  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.
authors.affiliation: Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy.
authors.forename: Samuele
authors.initials: S
authors.lastname: Naviglio
authors.affiliation: Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy.
authors.forename: Maria Valentina
authors.initials: MV
authors.lastname: Abate
authors.affiliation: Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Chinello
authors.affiliation: Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy; Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ventura
mesh_terms: D000293:Adolescent; D006801:Humans; D007244:Infectious Mononucleosis / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D013159:Splenic Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D014463:Ultrasonography
keywords: Epstein-Barr virus; infectious mononucleosis; lupus anticoagulant; splenic infarction; thrombosis