Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature

BACKGROUND: Atraumatic splenic rupture (ASR) accounts for just over 3% of all cases of splenic rupture and is associated with a high mortality rate. The most common culprit is acute infection with Epstein-Barr virus (EBV) but other documented aetiologies include neoplasia, other viral/bacterial infe...

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Autor principal: Kwok, Allan Mun Fai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912070/
https://www.ncbi.nlm.nih.gov/pubmed/31879535
http://dx.doi.org/10.4240/wjgs.v11.i12.433
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author Kwok, Allan Mun Fai
author_facet Kwok, Allan Mun Fai
author_sort Kwok, Allan Mun Fai
collection PubMed
description BACKGROUND: Atraumatic splenic rupture (ASR) accounts for just over 3% of all cases of splenic rupture and is associated with a high mortality rate. The most common culprit is acute infection with Epstein-Barr virus (EBV) but other documented aetiologies include neoplasia, other viral/bacterial infections, acute and chronic pancreatitis, amyloidosis and anticoagulant medications. There are four previous reports of cocaine-associated ASR but never before has it been documented in combination with concurrent acute EBV infection. CASE SUMMARY: A 21-year-old man presented to hospital with acute left shoulder pain which radiated to the right shoulder and upper abdomen. He denied any history of recent trauma and had no relevant past medical history. He took no regular prescription medications but had used cocaine within the previous 24 h. Investigations revealed splenomegaly, a Grade 3 subcapsular splenic haematoma, moderate haemoperitoneum and an incidental 9 mm splenic artery pseudoaneurysm. There was also serological evidence of acute EBV infection. Prophylactic endovascular embolisation of the pseudoaneurysm was performed and the splenic rupture was managed non-operatively. The patient remained admitted in hospital for seven days and did not require any transfusion of blood products. Serial imaging showed complete resolution of the haemoperitoneum after 5 wk. The importance of abstinence from illicit drug use was emphasised to the patient but it is unknown whether or not he remains compliant. CONCLUSION: This case demonstrates that ASR is a rare condition that can result from acute EBV infection and cocaine ingestion and requires a high index of suspicion to diagnose clinically.
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spelling pubmed-69120702019-12-27 Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature Kwok, Allan Mun Fai World J Gastrointest Surg Case Report BACKGROUND: Atraumatic splenic rupture (ASR) accounts for just over 3% of all cases of splenic rupture and is associated with a high mortality rate. The most common culprit is acute infection with Epstein-Barr virus (EBV) but other documented aetiologies include neoplasia, other viral/bacterial infections, acute and chronic pancreatitis, amyloidosis and anticoagulant medications. There are four previous reports of cocaine-associated ASR but never before has it been documented in combination with concurrent acute EBV infection. CASE SUMMARY: A 21-year-old man presented to hospital with acute left shoulder pain which radiated to the right shoulder and upper abdomen. He denied any history of recent trauma and had no relevant past medical history. He took no regular prescription medications but had used cocaine within the previous 24 h. Investigations revealed splenomegaly, a Grade 3 subcapsular splenic haematoma, moderate haemoperitoneum and an incidental 9 mm splenic artery pseudoaneurysm. There was also serological evidence of acute EBV infection. Prophylactic endovascular embolisation of the pseudoaneurysm was performed and the splenic rupture was managed non-operatively. The patient remained admitted in hospital for seven days and did not require any transfusion of blood products. Serial imaging showed complete resolution of the haemoperitoneum after 5 wk. The importance of abstinence from illicit drug use was emphasised to the patient but it is unknown whether or not he remains compliant. CONCLUSION: This case demonstrates that ASR is a rare condition that can result from acute EBV infection and cocaine ingestion and requires a high index of suspicion to diagnose clinically. Baishideng Publishing Group Inc 2019-12-27 2019-12-27 /pmc/articles/PMC6912070/ /pubmed/31879535 http://dx.doi.org/10.4240/wjgs.v11.i12.433 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Case Report
Kwok, Allan Mun Fai
Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature
title Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature
title_full Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature
title_fullStr Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature
title_full_unstemmed Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature
title_short Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature
title_sort atraumatic splenic rupture after cocaine use and acute epstein-barr virus infection: a case report and review of literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912070/
https://www.ncbi.nlm.nih.gov/pubmed/31879535
http://dx.doi.org/10.4240/wjgs.v11.i12.433
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