Splenic infarction in patients with Epstein-Barr virus infectious mononucleosis-case reports and literature review

Introduction: Epstein-Barr virus (EBV) is one of the most common herpes viruses in humans with over 90% of adults demonstrating antibodies to EBV. Infectious mononucleosis (IM) is the most frequently occurring clinical presentation of EBV infection and typically presents with fever, tonsillitis/pharyngitis, cervical lymph node enlargement and tenderness and fatigue. Splenomegaly is also part of the clinical presentation. Splenic infarction (SI) due to IM is rare but its exact frequency is unknown. Methods: We present two cases of SI accompanying IM caused by EBV in young adults without underlying comorbidities together with a literature review of this topic. Literature search included journal articles describing splenic infarctions confirmed by CT or MRI associated with IM due to EBV infection published in English between 2005 and 2024 in PubMed. A total of 32 case reports presenting 34 patients were selected for detailed analysis. Results: Among 34 patients, 58,8% were males and the median age was 20.97 years. Only 26.5% of patients had some chronic disease, the most common one being hereditary spherocytosis present in four patients. The most common symptoms were: fever (82.4%), abdominal pain (88.2%) localized mostly in the left upper abdomen and splenomegaly (50%). Conclusion: Our overall conclusion is that establishing the diagnosis of SI does not change the therapeutic approach in most cases and that symptomatic treatment is sufficient. In the future, greater availability of abdominal imagining methods and a higher index of suspicion will lead to more accurate data about SI.