Clinical Review Lesson of the week

Abdominal pain in acute infectious mononucleosis

BMJ 2002; 324 doi: (Published 16 March 2002) Cite this as: BMJ 2002;324:660
  1. Ann L N Chapman, specialist registrar in infectious diseases (,
  2. Richard Watkin, senior house physician,
  3. Christopher J Ellis, consultant in infectious diseases
  1. Department of Infection and Tropical Medicine, Heartlands Hospital, Birmingham B9 5SS
  • Accepted 29 August 2001

Abdominal pain in patients with infectious mononucleosis may signal splenic rupture

Abdominal pain and tachycardia are unusual in patients with acute infectious mononucleosis. We present a case in which abdominal pain and tenderness signalled the presence of a potentially fatal complication of infectious mononucleosis.

Case report

A previously fit 20 year old man was admitted with a three day history of fever, sore throat, dyspnoea, and malaise. Ten days before admission he had fallen on to his left side and had attended the casualty department with pain over the left chest wall. A chest radiograph did not show a fracture, but the pain had been sufficiently severe to warrant overnight observation in the casualty department.

On admission he was feverish, with a temperature of 39.7°C, and had generalised lymphadenopathy, non-exudative pharyngitis, mild hepatomegaly, and splenomegaly of 2 cm. He looked pale but well, and his blood pressure was 115/95 mm Hg, with a pulse rate of 96 beats/min. He had mild left and right hypochondrial tenderness without guarding.

Initial investigations showed a haemoglobin concentration of 10.9 g/dl, and a total leukocyte …

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