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Splenic Infarct: A Rare Complication of Infectious Mononucleosis in a Monospot-Negative Patient

Summary

A 21-year-old woman came to the hospital with fever, jaundice, and abdominal pain that persisted despite antibiotics. Although her monospot test for mononucleosis came back negative, blood tests for a virus called Epstein-Barr Virus (EBV) confirmed she had infectious mononucleosis. Imaging scans revealed multiple areas of dead tissue (infarcts) in her spleen caused by blocked blood vessels. She recovered well with rest and supportive care, highlighting how mononucleosis can sometimes cause serious complications even when the initial screening test is negative.

Background

Splenic infarction is a rare complication of infectious mononucleosis (IM) caused by Epstein-Barr Virus (EBV). The monospot test, commonly used to diagnose EBV-related IM, can produce false-negative results, particularly in atypical presentations or early stages of infection. This case report documents a monospot-negative patient who developed splenic infarction as a complication of IM.

Objective

To describe and analyze a case of splenic infarction in a monospot-negative patient with EBV-confirmed infectious mononucleosis. To highlight the diagnostic challenges of IM when monospot testing is negative and emphasize the need for EBV VCA antibody testing in suspected cases.

Results

The patient had a negative monospot test but tested positive for EBV VCA antibodies. Imaging revealed multiple wedge-shaped splenic infarcts with splenomegaly and mild hepatomegaly. Laboratory findings showed elevated liver enzymes, mild lymphocytosis with atypical lymphocytes, and thrombocytopenia. The patient was managed conservatively with supportive care and discharged after 14 days with resolution of symptoms.

Conclusion

This case demonstrates that splenic infarction should be considered as a potential complication of EBV infection in young adults, especially those using oral contraceptive pills. Clinicians should be aware of the limitations of monospot testing and pursue EBV serologies when clinical suspicion is high. Early diagnosis and conservative management can lead to favorable outcomes and prevent serious complications such as splenic rupture.
  • Published in:Cureus,
  • Study Type:Case Report,
  • Source: PMID: 39835048, DOI: 10.7759/cureus.76127
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