Possible Infectious Causes of Spontaneous Splenic Rupture
This case represents a common infectious disease dilemma of appropriate clinical management in the context of discordant clinical and serological findings. Although the history of a cat bite and clinical improvement after initiation of targeted therapy against Bartonella henselae is consistent with the diagnosis of ASR secondary to CSD, the Bartonella serologies were inconclusive. The clinical presentation was atypical of EBV yet the conversion of EBNA is suggestive of the diagnosis. In such difficult cases where inconclusive results are present, the skilled clinician must always remember to prioritize treatable diseases and address the wellbeing of the patient, not the results of serologies.
Given that infections explain approximately one-quarter of ASR cases, infectious etiologies should be on the differential when a patient presents with ASR. A detailed history and physical are required to screen for infectious causes although delineating the exact infectious etiology can be challenging with the limitation of serological diagnostics.
Conclusions
This case represents a common infectious disease dilemma of appropriate clinical management in the context of discordant clinical and serological findings. Although the history of a cat bite and clinical improvement after initiation of targeted therapy against Bartonella henselae is consistent with the diagnosis of ASR secondary to CSD, the Bartonella serologies were inconclusive. The clinical presentation was atypical of EBV yet the conversion of EBNA is suggestive of the diagnosis. In such difficult cases where inconclusive results are present, the skilled clinician must always remember to prioritize treatable diseases and address the wellbeing of the patient, not the results of serologies.
Given that infections explain approximately one-quarter of ASR cases, infectious etiologies should be on the differential when a patient presents with ASR. A detailed history and physical are required to screen for infectious causes although delineating the exact infectious etiology can be challenging with the limitation of serological diagnostics.
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