Atraumatic Splenic Rupture as the Sole Manifestation of Infectious Mononucleosis: A Case Report and Literature Review.

Atraumatic splenic rupture is an uncommon but life-threatening complication of Epstein-Barr virus (EBV) infection. While infectious mononucleosis classically presents with fever, pharyngitis, and lymphadenopathy, we recorded a spontaneous splenic rupture even in the absence of these symptoms. We report a case of a 26-year-old male presenting to the emergency department with syncope. A progressive clinical hemodynamic deterioration was detected, ending hemorrhagic shock. Imaging revealed an atraumatic grade V splenic injury and massive hemoperitoneum. Laboratory tests showed lymphocytosis, prompting EBV serology, which confirmed acute mononucleosis infection. Due to hemodynamic instability, the patient underwent splenectomy with uneventful recovery. This case highlights that EBV-related splenic rupture may represent the only manifestation of infection in otherwise asymptomatic individuals. Clinicians should maintain a high index of suspicion for EBV infection in patients presenting with unexplained atraumatic splenic rupture. Early diagnosis and timely management are crucial to reduce the risk of potentially life-threatening complications.