SHM Converge Scientific Abstract ePoster Gallery-A Sight to Be Spleen: A Rare Case of Splenic Infarct in Acute Cytomegalovirus Infection

Pdf Summary

This case report describes a rare presentation of acute cytomegalovirus (CMV) infection in an immunocompetent 46-year-old woman who presented with one week of fever, left upper quadrant abdominal pain, chills, night sweats, cough, nausea/vomiting, and headache. On exam, she had hepatosplenomegaly and abdominal tenderness. Labs showed hyponatremia, transaminitis, elevated alkaline phosphatase, macrocytic anemia, thrombocytopenia, and inflammatory marker elevation.<br /><br />Extensive workup for infection, thrombosis, endocarditis, and other causes of fever was largely negative, including blood cultures, respiratory and urine testing, CT head, lower-extremity ultrasound, transthoracic echocardiogram, and multiple serologies. CT imaging of the chest/abdomen revealed a wedge-shaped splenic infarct and severe hepatosplenomegaly. Her symptoms persisted despite empiric antibiotics and prednisone.<br /><br />Ultimately, monospot testing was positive, and CMV testing showed CMV IgM positivity with a markedly elevated CMV viral load, while CMV IgG was negative, confirming acute CMV infection. She was diagnosed with acute CMV and discharged with supportive care.<br /><br />The report emphasizes that although CMV infection in immunocompetent adults is often asymptomatic or causes a self-limited mononucleosis-like illness, it can rarely be associated with venous thromboembolism and splenic infarction. Proposed mechanisms include splenomegaly causing vascular compression, CMV-related hypercoagulability, or rapid splenic enlargement outpacing blood supply. The key takeaway is that CMV should remain on the differential diagnosis for immunocompetent patients with unexplained fever and splenic infarct.

Asset Subtitle

Donya Mazdeyasnan

Meta Tag

Author List Ashley Scanlon, Donya Mazdeyasnan

Category Clinical Vignettes

Concept Cytomegalovirus Infection

Concept Immunocompetent Patient

Concept Immunocompromised State

Concept Splenic Infarction

Concept Mononucleosis-like Syndrome

Distinguished Non-Finalist

Presenter Organization University of California, San Diego School of Medicine

Presenting Author Donya Mazdeyasnan

Track Adult

Keywords

cytomegalovirus

CMV infection

immunocompetent adult

splenic infarct

hepatosplenomegaly

fever of unknown origin

mononucleosis-like illness

thrombocytopenia

transaminitis

viral load

Cytomegalovirus Infection

Immunocompetent Patient

Immunocompromised State

Splenic Infarction

Mononucleosis-like Syndrome