A Rare Complication of Atraumatic Splenic Rupture in Infectious Mononucleosis: A Case Report

Aims/Background Atraumatic splenic rupture is a very rare and potentially life-threatening event usually associated with underlying pathological conditions. Splenic rupture in infectious mononucleosis occurs only in 0.1%-0.5% of patients. The aim of the present study was to publish a case report of the atraumatic splenic rupture and to present a mini-review of the international literature. Case Presentation A 30-year-old man of mixed races (Caucasian and African) diagnosed with acute cholecystitis was referred by a rural doctor to a secondary district hospital. His past medical and family history was unremarkable. He did not report any allergies. On arrival, his vital signs were stable. However, laboratory examinations demonstrated: white blood cells 26 x 10(3)/mu L (4-11), neutrophils 38.8% (35%-72%), lymphocytes 58% (20%-45%), red blood cells 3.59 M/mu L (0-0.6), haemoglobin 10.9 g/dL (13.5-17.5), haematocrit 33.4% (40%-54%), platelets 11.5 fL (6.5-11), prothrombin time 13.2 s (9.4-12.5), glucose 70 mg/dL (74-107), sodium 135 mmol/L (137-146), calcium 7.6 mg/dL (8.8-106), serum glutamic-oxaloacetic transaminase 426 U/L (10-45), serum glutamate pyruvate transaminase 530 U/L (7-45), gamma glutamyl transferase 151 U/L (7-49), total albumins 5.3 g/dL (6.6-8.3), C-reactive protein 235 mg/L (<5), and Epstein-Barr virus 15.50 S/CO (0-1.0). In addition, computed tomography determined hepatosplenomegaly, haemoperitoneum, and spleen rupture. Physical examination revealed abdominal rigidity, left shoulder tip pain, shortened capillary refill time, and neck lymphadenopathy. Results The patient underwent expeditious total splenectomy, postoperative period was uneventful and he was discharged on the sixth postoperative day. He was scheduled to undergo the post-splenectomy vaccinations and regular follow-ups with his general practitioner abroad. Conclusion In patients without a history of trauma, spontaneous splenic rupture should be considered in the differential diagnosis if patients have complaints of abdominal and left shoulder tip pain, and laboratory results indicate low haemoglobin and haematocrit levels.