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Cytomegalovirus-Associated Splenic Infarction

Published:October 14, 2019DOI:https://doi.org/10.1016/j.amjmed.2019.09.011
      A healthy 34-year-old woman was admitted with new-onset left upper quadrant pain in the setting of a prolonged febrile illness. She had fever (>38.3°C) for 3 weeks associated with fatigue, lassitude, myalgia and night sweats, but no weight loss. Her 1-year-old child had been recently diagnosed with “mononucleosis.” Sudden severe epigastric and left upper quadrant pain prompted her referral. Examination showed low-grade fever and mild upper abdominal tenderness without palpable spleen or lymphadenopathy. The patient's hemoglobin level was 11.6 g/dL, white blood cell count 6.4 × 109/L (neutrophils 2.3, then 1.54 × 109/L; lymphocytes 3.4 × 109/L, 12% atypical), platelets 205× 109/L with normal serum albumin (globulins 3 g/dL). She also had mild transaminitis (50-60 IU/L, N≤33, lactate dehydrogenase similarly increased) and normal cholestatic enzymes and bilirubin. A urinalysis was also normal. C-reactive protein was 8.6 initially, then 36.5 mg/dL. Cytomegalovirus IgG and IgM were increased and cytomegalovirus chain reaction was positive. Other viruses (Epstein-Barr virus, hepatitis A virus, hepatitis B virus, hepatitis C virus, human immunodeficiency virus) were not found. Electrocardiogram, chest X-ray, and abdominal ultrasound were normal. Computed tomography scan (for suspected urolithiasis) revealed a single splenic infarct Fig). She recovered spontaneously within 4 days and remains well. Echocardiography was normal, and no antiphospholipid antibodies or other hypercoagulability had been found. However, she was using contraceptive pills.
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