Silent Splenic Infarction Following Infectious Mononucleosis Associated with Antiphospholipid Antibodies in a Pediatric Patient: A Case Report
DOI:
https://doi.org/10.58427/apghn.4.2.2025.78-82Keywords:
antiphospholipid antibodies, epstein-barr virus, mononucleosis, pediatric, splenic infarctionAbstract
Background: The splenic infarction (SI) is a rare complication of infectious mononucleosis (IM), especially in paediatric population. The clinical presentation of this condition can vary widely, but it is most often symptomatic (e.g. pain in the left upper quadrant).
Case: We report a case of a previously healthy 12 year old female with a silent splenic infarction (SI) following IM by Epstein-Barr virus (EBV), positive for antiphospholipid anti-cardiolipin IgM antibodies (ACA IgM).
Discussion: Numerous pathogenetic mechanisms have been proposed for the SI in the course of IM. The definitive diagnosis of SI is made with CT; in our case, given the lack of urgent clinical indications, the definitive diagnosis was made with MRI. Follow-up was continued using ultrasound and therapeutic management was conservative.
Conclusion: We describe a rare case of asymptomatic splenic infarction, in a girl with no underlying predisposing condition. It is important for a pediatrician to be aware of this possible complication and its correct therapeutic management.
References
Antopolsky M, Hiller N, Salameh S, Goldshtein B, Stalnikowicz R. Splenic infarction: 10 years of experience. Am J Emerg Med. 2009;27(3):262-5. https://doi.org/10.1016/j.ajem.2008.02.014 DOI: https://doi.org/10.1016/j.ajem.2008.02.014
Heo DH, Baek DY, Oh SM, Hwang JH, Lee CS, Hwang JH. Splenic infarction associated with acute infectious mononucleosis due to epstein-barr virus infection. J Med Virol. 2017;89(2):332-6. https://doi.org/10.1002/jmv.24618 DOI: https://doi.org/10.1002/jmv.24618
Choi B, Kwon B, Kim GB, Jeon H-Y, Cheon J-E, Bae E, et al. A case of adolescent kawasaki disease with epstein-barr virus-associated infectious mononucleosis complicated by splenic infarction. Korean Journal of Pediatrics. 2009;52:1029. https://doi.org/10.3345/kjp.2009.52.9.1029 DOI: https://doi.org/10.3345/kjp.2009.52.9.1029
Naviglio S, Abate MV, Chinello M, Ventura A. Splenic infarction in acute infectious mononucleosis. J Emerg Med. 2016;50(1):e11-3. https://doi.org/10.1016/j.jemermed.2015.09.019 DOI: https://doi.org/10.1016/j.jemermed.2015.09.019
van Hal S, Senanayake S, Hardiman R. Splenic infarction due to transient antiphospholipid antibodies induced by acute epstein-barr virus infection. J Clin Virol. 2005;32(3):245-7. https://doi.org/10.1016/j.jcv.2004.07.013 DOI: https://doi.org/10.1016/j.jcv.2004.07.013
Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (aps). J Thromb Haemost. 2006;4(2):295-306. https://doi.org/10.1111/j.1538-7836.2006.01753.x DOI: https://doi.org/10.1111/j.1538-7836.2006.01753.x
Ben-Chetrit E, Wiener-Well Y, Fadeela A, Wolf DG. Antiphospholipid antibodies during infectious mononucleosis and their long term clinical significance. J Clin Virol. 2013;56(4):312-5. https://doi.org/10.1016/j.jcv.2012.12.011 DOI: https://doi.org/10.1016/j.jcv.2012.12.011
von Landenberg P, Döring Y, Modrow S, Lackner KJ. Are antiphospholipid antibodies an essential requirement for an effective immune response to infections? Ann N Y Acad Sci. 2007;1108:578-83. https://doi.org/10.1196/annals.1422.060 DOI: https://doi.org/10.1196/annals.1422.060
Carrasco M, Galarza-Maldonado C, Mendoza-Pinto C, Escárcega R, Cervera R. Infections and the antiphospholipid syndrome. Clinical reviews in allergy & immunology. 2009;36:104-8. https://doi.org/10.1007/s12016-008-8103-0 DOI: https://doi.org/10.1007/s12016-008-8103-0
Abdel-Wahab N, Lopez-Olivo MA, Pinto-Patarroyo GP, Suarez-Almazor ME. Systematic review of case reports of antiphospholipid syndrome following infection. Lupus. 2016;25(14):1520-31. https://doi.org/10.1177/0961203316640912 DOI: https://doi.org/10.1177/0961203316640912
Serrano M, Espinosa G, Cervera R, Serrano A. Covid-19 coagulopathy and antiphospholipid syndrome. Revista Colombiana de Reumatología. 2022;29:S25-S34. https://doi.org/10.1016/j.rcreu.2021.02.013 DOI: https://doi.org/10.1016/j.rcreu.2021.02.013
Gang MH, Kim JY. Splenic infarction in a child with primary epstein-barr virus infection. Pediatr Int. 2013;55(5):e126-8. https://doi.org/10.1111/ped.12143 DOI: https://doi.org/10.1111/ped.12143
Turrian U. Splenic infarction after epstein-barr virus infection: Case report. Annals of Clinical Case Reports. 2021;6. https://doi.org/10.25107/2474-1655.2045
Khan S, Saud S, Khan I, Prabhu S. Epstein barr virus-induced antiphospholipid antibodies resulting in splenic infarct: A case report. Cureus. 2019;11(2):e4119. https://doi.org/10.7759/cureus.4119 DOI: https://doi.org/10.7759/cureus.4119
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