A Case Report on a Patient with Epstein-Barr Virus Infection Complicated by Non-traumatic Splenic Rupture
This case report describes a 42-year-old male with Epstein-Barr virus infection who presented with chest pain mimicking acute coronary syndrome but was successfully diagnosed with life-threatening nontraumatic splenic rupture via aortic CT, highlighting the critical need for clinicians to consider this rare complication to avoid misdiagnosis and improve patient outcomes.
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The human body is a complex system where a single infection can sometimes trigger a chain reaction far removed from the initial symptoms. One such infection is caused by the Epstein-Barr virus, a common germ that spreads easily between people and often causes a condition known as infectious mononucleosis. While most people recover from this illness with rest and time, the virus can occasionally cause the spleen, an organ located in the upper left side of the abdomen that filters blood, to become swollen and fragile. In very rare instances, this fragile spleen can tear open without any external injury, a life-threatening event known as a nontraumatic splenic rupture. Because the symptoms of a rupturing spleen can sometimes mimic other serious conditions, such as a heart attack, doctors must be extremely careful to identify the true cause quickly to save a patient's life.
This case report details the experience of a forty-two-year-old man who arrived at a hospital in Beijing complaining of a poor appetite and vomiting. Initial tests showed his liver was struggling, and scans revealed that his spleen was enlarged along with several swollen lymph nodes in his abdomen. Doctors confirmed he had an active Epstein-Barr virus infection and began treatment to protect his liver. For the first few days, the patient seemed to be on a steady path toward recovery. However, on the third day of his hospital stay, his condition changed dramatically. He suddenly developed severe chest pain that lasted for seven hours, accompanied by dizziness, heavy sweating, and a feeling that something terrible was about to happen. His blood pressure dropped dangerously low, and his heart rhythm showed minor irregularities.
At first, the symptoms pointed toward a heart problem, specifically a condition called acute coronary syndrome, which requires immediate treatment with blood-thinning medications. However, the medical team exercised caution. Before giving any drugs that could thin the blood, a cardiologist ordered a special scan of the chest and abdomen to rule out a tear in the main artery, known as an aortic dissection. This critical decision proved to be the turning point. The scan did not show a heart attack or an aortic tear. Instead, it revealed a catastrophic event in the abdomen: the patient's spleen had ruptured. Blood was leaking from the organ into the abdominal cavity, causing the shock and the severe pain. The chest pain he felt was not coming from his heart, but was a referred pain caused by the blood irritating the diaphragm, the muscle that separates the chest from the abdomen.
Once the true diagnosis was made, the team shifted their strategy immediately. Instead of treating a heart condition, they focused on stopping the internal bleeding. The patient was moved to an intensive care unit where doctors performed a procedure to block the artery feeding the spleen, a technique called embolization, which stopped the bleeding without removing the organ. He also received fluids, blood transfusions, and medications to support his blood pressure and fight the infection. Over the next two weeks, his condition stabilized. A follow-up scan eight days after the rupture showed that the bleeding had stopped and the injury was healing. The patient eventually regained his strength, began walking again, and was sent home with instructions to monitor his health closely.
This case highlights a rare but dangerous complication where a common virus leads to a sudden, life-threatening rupture of the spleen. What makes this story particularly significant is the unusual way the patient presented. Most people with a ruptured spleen feel pain in the abdomen or the left shoulder. This patient, however, felt intense pain in his chest, which closely resembled a heart attack. If the doctors had treated him for a heart condition by giving him blood thinners, the internal bleeding would have worsened, likely leading to a fatal outcome. The successful outcome depended on the medical team's ability to pause, consider alternative causes for the chest pain, and use imaging technology to find the real problem. It serves as a reminder that even when symptoms seem to point in one direction, the body can sometimes signal distress in unexpected ways, requiring doctors to look beyond the obvious to save a life.
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