Yamamoto Takeru, Sada Ryuichi Minoda, Yamamoto Shungo, Hosokawa Naoto, Kutsuna Satoshi
Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Japan.
Department of Infection Control, Graduate School of Medicine, The University of Osaka, Japan.
IDCases. 2025 May 25;40:e02271. doi: 10.1016/j.idcr.2025.e02271. eCollection 2025.
A 30-year-old previously healthy man presented with a 10-day history of fever, generalized fatigue, sore throat, and arthralgia. Physical examination revealed tender cervical lymphadenopathy and right upper abdominal discomfort on palpation. Laboratory tests showed a white blood cell count of 12,100 cells/µL with 21 % atypical lymphocytes, and elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels at 174 U/L and 339 U/L, respectively. Contrast-enhanced abdominal computed tomography (CT) performed to evaluate the abdominal discomfort revealed hepatosplenomegaly and a wedge-shaped low-attenuation area in the spleen, consistent with splenic infarction. Subsequent serologic testing was positive for Epstein-Barr virus (EBV) viral capsid antigen immunoglobulin M (IgM) and negative for Epstein-Barr nuclear antigen antibodies, confirming a diagnosis of primary EBV infection. The patient subsequently became afebrile, his symptoms resolved spontaneously, and his AST and ALT levels normalized. Follow-up CT imaging showed a slight reduction in the size of the splenic infarction at 5 weeks, and a marked reduction at 8 weeks. Splenic infarction is a rare but recognized complication of primary EBV infection. Although it generally has a favorable prognosis, careful clinical monitoring is essential due to the potential risk of splenic rupture, which may necessitate splenectomy. Some cases have been treated with anticoagulation therapy; however, most, including this patient, improve with supportive care alone. This case highlights the spontaneous healing of EBV-associated splenic infarction demonstrated through serial imaging and suggests that follow-up imaging may be unnecessary in the absence of abdominal symptoms.
一名30岁既往健康的男性，出现发热、全身乏力、咽痛和关节痛10天。体格检查发现颈部淋巴结压痛，触诊右上腹不适。实验室检查显示白细胞计数为12,100个/µL，非典型淋巴细胞占21%，天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）水平升高，分别为174 U/L和339 U/L。为评估腹部不适而进行的腹部增强计算机断层扫描（CT）显示肝脾肿大，脾脏有一个楔形低密度区，符合脾梗死表现。随后的血清学检测显示，爱泼斯坦-巴尔病毒（EBV）病毒衣壳抗原免疫球蛋白M（IgM）呈阳性，爱泼斯坦-巴尔核抗原抗体呈阴性，确诊为原发性EBV感染。患者随后体温恢复正常，症状自行缓解，AST和ALT水平恢复正常。随访CT成像显示，5周时脾梗死灶大小略有缩小，8周时明显缩小。脾梗死是原发性EBV感染一种罕见但已被认识的并发症。虽然其预后通常良好，但由于存在脾破裂的潜在风险，可能需要行脾切除术，因此仔细的临床监测至关重要。一些病例已接受抗凝治疗；然而，大多数病例，包括该患者，仅通过支持治疗即可改善。本病例通过系列成像显示了EBV相关性脾梗死的自愈情况，并提示在无腹部症状时可能无需进行随访成像。
