No study provides high level of evidence on this subject; therefore, clinical judgment is still essential. Splenic enlargement is common in infectious mononucleosis (IM), but rupture is an uncommon sequelae. A systematic review of case reports/ series demonstrates a majority of splenic ruptures occurring in the first 3 weeks. In an afebrile patient with resolving symptoms, return to “non-contact” activity is appropriate at that time. Level of exertion should be guided by patient’s energy. Return to “contact” activity should have a delay of at least 3 weeks. Physical exam cannot accurately detect splenomegaly. Imaging with serial U/S to monitor changing spleen size may be considered in a patient with early resolution of IM symptoms who is considering early return to activity.
Most instances of splenic rupture due to infectious mononucleosis occur during the first 3 weeks of illness..
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