Blood, 1946, Vol. 1, No. 4, pp. 317-333.
© 1946 American Society of Hematology, Inc.
RUPTURE OF THE SPLEEN IN INFECTIOUS MONONUCLEOSIS
A CLINICOPATHOLOGIC REPORT OF SEVEN CASES
E. B. SMITH M.C.1 and
R. P. CUSTER M.C.1
1 Army Institute of Pathology, Washington, D.C.
1. Seven cases of ruptured spleen as a complication of infectious mononucleosis
are described and reference made to the 3 cases previously recorded in the literature.
2. It proved possible to make an objective histologic diagnosis of infectious
mononucleosis from well prepared sections of the spleens. The diagnosis was
based on: (a) a blurred architectural pattern due chiefly to large numbers of atypical lymphocytes diffused throughout the pulp and clumped in the blood sinuses;
(b) small, poorly defined follicles, usually without germinal centers, in less than
usual numbers per unit area; (c) cellular "infiltrates," composed largely of normal
and atypical lymphocytes, in the capsule and trabeculae, in the adventitia of
small intratrabecular arteries, and in the subintimal zone of collecting venous
sinuses and intratrabecular veins; (d) swelling of the lining or attached cells of
the blood sinuses.
3. "Infiltration" of the capsule and trabeculae reached considerable proportions, occasionally to the point of complete dissolution of these structures, and
served as a predisposing cause of rupture. The same changes were noted in intact
spleens from fatal cases of infectious mononucleosis.
4. The spleen in infectious mononucleosis was 3 to 4 times normal size and
ruptured during the third or fourth week of the disease.
5. The importance of trivial injury as the exciting cause of so-called "spontaneous" rupture of the spleen has been emphasized. It is recommended that
extreme caution be employed during attempted palpation of the spleen in a suspected case of the disease. When the diagnosis is obvious, splenic palpation may
well be omitted.
