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June 18, 1982

Spontaneous Subcapsular Splenic Hematoma as the Only Clinical Manifestation of Infectious Mononucleosis

Author Affiliations

From the Department of Surgery, Rochester General Hospital and the University of Rochester, Rochester, NY.

JAMA. 1982;247(23):3243-3244. doi:10.1001/jama.1982.03320480059027

SPONTANEOUS rupture of the spleen due to infectious mononucleosis was first reported by King1 in 1941. Of 107 reported cases of splenic rupture associated with infectious mononucleosis, only 18 are considered to be true spontaneous ruptures.2 This is the report of a symptomatic, unruptured subcapsular hematoma in a patient with a high heterophil antibody titer and no other signs or symptoms. Two patients in a series of 500 consecutive cases of infectious mononucleosis probably had subcapsular splenic hematoma.3

Report of a Case  A 20-year-old man was asymptomatic except for the sudden onset of left upper quadrant abdominal pain. When examined in the emergency room on April 25, 1979, his left upper abdomen was mildly tender, but there were no other pertinent findings except for a hematocrit reading of 38% and a hemoglobin level of 13.6 g/dL. Three days later, he was admitted because of persistent abdominal pain