Splenic Infarction in a Patient with HIV and EBV Co-Infection

Splenic infarction occurs when there is partial or complete obstruction of its blood supply. It is associated with various conditions including mononucleosis, cytomegalovirus infection, malaria, malignancies and clotting factor disorders, among others. We present a case of a 50-year-old male who developed splenomegaly with splenic infarction in the setting of HIV and EBV coinfection. The patient presented with fever, abdominal pain, dizziness, dysuria and chills for four days. He reported unintentional non-quantifiable weight-loss. His past medical history included hypertension, prostatitis, and GERD. He was tachycardic on presentation. The physical examination was significant for prostate tenderness. He had anemia and lymphopenia. CT scan of the chest, abdomen, and pelvis revealed splenomegaly with splenic infarction and diffuse lymphadenopathy. COVID 19 infection was ruled out. The patient was found to have Epstein Barr viral infection as well as AIDS. During the hospitalization, he developed bilateral pneumonia and septic shock. He had to be intubated, was started on mechanical ventilation and transferred to ICU. Unfortunately, the patient continued to decompensate and expired. This case raises the awareness of thromboembolic complications that can occur during the course of viral infections especially when there is co-infection with more than one virus. The causes of splenic infarction in the setting of infectious mononucleosis include increased demand of the hypercellular spleen, transient hypercoagulable state during acute infection due to acute elevation in antiphospholipid antibodies, lupus anticoagulant and factor VIII as well as increased levels of circulating immune complexes due to B-cell proliferation which promotes leukocyte aggregation.