A 23-year-old Caucasian male was admitted to the emergency department of our hospital due to severe left upper quadrant abdominal pain. His medical history was free, and no recent trauma was reported. Clinical examination revealed no pyrexia, heart rate at 90 per minute, and normal blood pressure. Upon physical examination, upper abdominal tenderness was revealed. On auscultation, abdominal sounds were present. Rectal examination showed an empty rectum.
The emergent laboratory tests revealed the following: WBC 24350/mm3, hemoglobin 14,2 g/dl, platelets 278000/mm3, c-reactive protein 17 mg/dl, Tbil 1,9 mg/dl, Dbil 0,28, ast 27 IU/L, alt 42 IU/L, and creatinine and electrolytes were normal. An abdominal ultrasound showed splenomegaly (17,27 x 8,7 cm) and free fluid in the left iliac fossa and in pelvis (Figures 1 and 2). The urgent abdominal computerized tomography (CT) confirmed an enlarged spleen and showed a splenic hematoma with the presence of free fluid in the paracolic gutters and pelvis. There was a hyperdense component within the free fluid, indicating hemoperitoneum (Figure 3).
The patient was managed conservatively because of his hemodynamic stability. The diagnosis of primary CMV infection was made with positive IgM anti-CMV antibodies. He was under close monitoring and surgical supervision. He was hemodynamically stable all the time, and two weeks later a new CT of the abdomen was arranged. CT demonstrated the same splenic hematoma and a little resolution of the peritoneal effusion (Figure 4). After a period of prolonged bed rest (twenty days), the patient was discharged from the hospital with the advice to avoid extreme sports and activities. Five months later, followup with ultrasound examinations showed progressive resolution of the splenic hematoma and complete resolution of the peritoneal effusion.