2023 Volume 162 Pages 79-85
The patient was a 27-year-old man who presented with antibiotic-resistant fever, sore throat, cough, and abdominal pain for the past 5 days. During laryngoscopy performed by a local otorhinolaryngologist, he became pale and was brought to our hospital emergency room in a shock state and worsened left upper abdominal pain. Blood examination revealed abnormal results of liver function tests, elevated serum CRP and white blood cell counts, atypical lymphocytes, a positive result of serology for EBV VCA-IgM antibody, and a negative result of serology for EBNA ab. CT showed an enlarged liver and spleen, and splenic laceration and hemorrhage. Based on the findings, we made the diagnosis of splenic injury due to splenomegaly caused by infectious mononucleosis (an infection caused by EBV). Fortunately, the injury was mild, and the patient could be treated conservatively.
Infectious mononucleosis is a disease that is commonly encountered by otorhinolaryngologists. Nevertheless, there have been few reports of cases in Japan, and we considered a case such as ours as being very rare. However, in the MEDLINE and EMBASE databases (1984–2014), we found 81 cases of splenic rupture associated with EBV-infected infectious mononucleosis reported from Europe and the United States, and the fatality rate was reported to be as high as 9%. It is well known that this difference is due to the fact that patients were infected with EBV before their childhood due to the customs that were practiced in Japan. For example, the custom of passing food from parent to child by mouth during childhood. With the disappearance of such customs in recent years, the number of cases of EBV infection in adolescence is increasing, and it is expected that the number of cases of splenic injury will also begin to increase.
We hope that this report will contribute to raising the general awareness about such cases.
