Abstract
Splenic infarction with infectious mononucleosis (IM) caused by Epstein-Barr Virus (EBV) has been reported as a rare complication of IM. The monospot test, often used to diagnose EBV-related IM, may produce false-negative results, especially in atypical presentations or early stages of infection. This report describes the case of a monospot-negative patient who developed splenic infarction as a complication of IM. The pathophysiology of splenic infarction in IM remains poorly understood, though it is thought to be related to splenic congestion, thrombophilia, or the direct impact of EBV on the spleen's vasculature. This case report illustrates the diagnostic challenges and clinical significance of splenic infarction in a 21-year-old female who presented with fever, jaundice, fatigue, and mild abdominal discomfort. She was found to have splenic infarcts on imaging. Her monospot test was negative. However, she was diagnosed with EBV infection on EBV viral capsid antigen (VCA) antibody testing. This case also emphasizes the importance of clinical vigilance in diagnosing and managing rare complications of IM, even in the absence of positive monospot results, and highlights the need for further investigation into the mechanisms that predispose certain individuals to splenic infarction during infectious mononucleosis.