Spontaneous splenic rupture due to infectious mononucleosis requiring splenectomy: clinical challenges and management.

A male patient in his late teens initially presented with severe left upper abdominal pain, following a week of influenza-like symptoms. Initially, he presented to his GP, who diagnosed him with bacterial tonsillitis and treated him with clarithromycin. His clinical condition deteriorated further with severe vomiting and abdominal pain. Clinical assessment in accident and emergency revealed tachycardia, splenomegaly, lymphadenopathy and metabolic acidosis. Investigations confirmed Epstein-Barr virus infection, splenic rupture and haemoperitoneum, requiring an emergency splenectomy. He received blood transfusions due to a severe, sudden drop in his haemoglobin with haemodynamic instability.Postoperative management included admission to the intensive care unit sedated and intubated. He was in the intensive care unit for a few days before being extubated and stepped down to the ward. Follow-up included outpatient clinic visits and vaccinations against encapsulated organisms due to increased infection risks. The patient's recovery was uneventful, with no complications.