ATRAUMATIC SPLENIC RUPTURE AS THE INITIAL PRESENTATION OF PRIMARY EPSTEIN-BARR VIRUS INFECTION IN AN ADULT: A CASE REPORT

Atraumatic splenic rupture is rare, but missing the diagnosis can have serious consequences. Epstein-Barr virus (EBV) infection is one of its uncommon infectious causes, and in some patients the splenic complication is the first sign of the illness. A previously healthy 34-year-old man presented with 10 days of epigastric and left upper-quadrant pain, fever, fatigue, and loss of appetite. He denied abdominal trauma and remained hemodynamically stable. His hemoglobin was 12.4 g/dL, leukocyte count 9 × 10⁹/L, and platelet count 875 × 10⁹/L. Liver tests showed both hepatocellular and cholestatic abnormalities. Contrast-enhanced computed tomography revealed a 20-mm-thick subcapsular splenic hematoma extending over 105 mm, together with a small hemoperitoneum, despite a spleen of normal size. Initial EBV serology showed positive viral capsid antigen (VCA) IgM, negative VCA IgG, and negative Epstein-Barr nuclear antigen (EBNA) IgG, with positive EBV polymerase chain reaction. Repeat serology demonstrated VCA IgG seroconversion 15 days after symptom onset, strongly supporting acute primary EBV infection. Because the patient was stable and there was no evidence of significant ongoing bleeding, we chose nonoperative management with close observation. The follow-up scan was reassuring, and he was discharged in good condition after five days. This case shows that an EBV-related splenic injury may occur without splenomegaly and that conservative treatment can be successful when the patient is carefully selected and closely monitored.