Review Question - QID 214471

This patient has infectious mononucleosis (IM). Due the risk of splenic rupture, return to play should occur 3 weeks after symptom resolution with no evidence of splenomegaly.

IM is caused by the Epstein-Barr virus (EBV) and has a reported annual incidence is 1-3% in college students. Often, patients will present with fever, pharyngitis, and lymphadenopathy (Hoagland's triad); however, a rash and splenomegaly may also be evident. Splenic rupture is a rare but serious complication of IM. Rupture occurs following a sudden increase in portal venous pressure and is most prevalent within the first 3 weeks of illness. Patients may return to play approximately 3 weeks after the resolution of symptoms with no evidence of splenomegaly. Ultrasound has been used to demonstrate that the spleen has returned to normal size. Splenic rupture has been reported in nonathletes as well as in patients with normal-sized spleens.

Auwaerter et al. review the manifestations of IM in adolescents and young adults. They report that common symptoms include pharyngitis, lymph node enlargement, and transient fatigue. They found that the rare complication of splenic rupture serves a pivotal role in the decision for returning athletes to strenuous physical activities. They recommend a return to all sports in those without spleen enlargement 4 weeks after the onset of illness.

Kinderknecht et al. review IM. They report that while splenomegaly is common, splenic rupture is very rare. They found that an athlete's ability to return to activity usually relates to the presence of splenomegaly and the duration of the illness. They concluded that a splenic rupture has not been reported after an individual has been ill for more than 3 weeks.

Incorrect Answers:
Answers 1,2&5: return to play now would have too great of a risk for splenic rupture. This patient should not return to play for at least another 2 more weeks.
Answer 3: A course of oral valacyclovir is not needed for the resolution of IM