Splenic Infarctions in Acute Epstein-Barr Virus Infection: A Rare but Possibly Underdiagnosed Complication in Adults.

Background: Although splenomegaly is a common finding in Epstein-Barr virus (EBV) infection, splenic infarction is rarely reported and may be under-recognised, especially in adults. Neurological complications such as aseptic meningitis are also uncommon but documented. The simultaneous occurrence of both complications in the context of primary EBV infection is exceptional. Case description: We describe the case of a 56-year-old previously healthy man who presented with fever and abdominal pain. Abdominal computed tomography (CT) revealed splenomegaly and multiple wedge-shaped splenic infarcts. During admission, the patient developed transient disorientation, and cerebrospinal fluid analysis was consistent with aseptic meningitis. Serological and molecular testing confirmed acute EBV infection in blood, pharyngeal swab and cerebrospinal fluid. No underlying prothrombotic condition was identified. The patient recovered completely with supportive care, without the need for antiviral treatment or anticoagulation. Conclusions: Splenic infarction is a rare but possibly underestimated complication of primary EBV infection, particularly in adults. Awareness of this association can help avoid unnecessary investigations or treatments. In selected patients, conservative management without anticoagulation may be appropriate. LEARNING POINTS: Splenic infarctions are a rare but potentially severe complication of primary Epstein-Barr virus infection.EBV-related mononucleosis in adults may present with atypical features, including neurological involvement such as aseptic meningitis.Awareness of these complications may facilitate earlier diagnosis and appropriate supportive management.