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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rupture of the spleen occurred in two patients (a man of 32 and a girl of 16 years) with serologically proven infectious mononucleosis. No history of trauma as a cause of the rupture could be elicited in either patient, despite intensive questioning. Abdominal symptoms were left-sided upper abdominal pain radiating into the left shoulder (Kehr's sign). The suspected diagnosis was confirmed by ultrasound demonstration of free abdominal fluid and abnormal splenic structure. Splenectomy had to be performed in both patients.
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PMID:[Spontaneous rupture of the spleen in infectious mononucleosis]. 268 28

Infectious mononucleosis is an acute viral illness associated with a high incidence of splenomegaly, although the incidence of splenic rupture is low. When rupture occurs, the mortality has been significant, presumably, because a history of trauma is not present. The spleen may be vulnerable to injury due to the histopathologic changes that occur as a result of this illness. Essentially all patients with spontaneous rupture related to infectious mononucleosis have epigastric or upper abdominal pain. The diagnosis of splenic rupture may be confirmed in a variety of ways. In those patients who are hemodynamically stable, CT scan, ultrasound, or radionuclide scan may aid in establishing the diagnosis. Selective splenic angiography is very accurate but has been largely abandoned because of the invasive nature of the study. Peritoneal lavage is efficacious in establishing the diagnosis in hemodynamically unstable patients. The treatment of choice, at this time, is splenectomy. Current interest in splenic salvage has resulted in reports of nonoperative therapy in stable patients and splenorrhaphy in one instance. Due to the extent of the histologic changes in the spleen, caution is urged in electing the conservative approach to this clinical situation.
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PMID:Splenic rupture and infectious mononucleosis. 269 60

Three patients with infectious mononucleosis and splenic injury were managed nonoperatively. Mechanisms of injury included significant left upper quadrant trauma during a football game in a 17-year-old boy, a minor fall in a 16-year-old girl, and no apparent trauma in the remaining patient, a 28-year-old man. All had significant abdominal pain and two were hypotensive upon admission. All had computerized tomographic scan documentation of splenic enlargement, significant injury, and free peritoneal blood. Paracentesis was not performed. Only the first patient received transfused blood. The hospitalization period ranged from nine to 14 days. Gradual and finally complete healing (return to normal size) was documented in all three patients. Follow-up is 66, 14, and 10 months. Although clearly controversial and not free from danger, successful nonoperative management of the injured enlarged spleen in select patients with mononucleosis is possible in an appropriate setting.
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PMID:Splenic injury: nonoperative management in three patients with infectious mononucleosis. 272 83

Between 1976 and 1982, 113 children aged 6 months to 16 years with documented Epstein-Barr virus-induced infectious mononucleosis were studied prospectively, and in most instances serially. An unexpected finding was the large number of young children, less than 4 years old, with this disease. Children with infectious mononucleosis, in particular the very young, tended to have more rashes, significant neutropenia, abdominal pain (older children only), and possible hepatosplenomegaly than have been reported in adult patients. The intensity of the characteristic relative atypical lymphocytosis found in peripheral blood was age-related; it was less in the very young. Findings of failure to thrive, otitis media, and episodes of recurrent tonsillopharyngitis appeared to be unique or more closely associated with childhood disease. Complications such as thrombocytopenia with hemorrhagic manifestations, significant airway obstruction, and neurologic problems occurred more frequently whereas jaundice occurred less frequently than noted in adult patients. Six children, all less than 4 years old, developed pneumonia during the disease course. The increased availability of Epstein-Barr virus-specific testing should continue to expand our knowledge of this disease in children of all ages.
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PMID:Epstein-Barr virus infectious mononucleosis in children. I. Clinical and general laboratory findings. 298 84

The histological changes in cytomegalovirus (CMV) infection were first described by RIBBERT in 1881, and for years the virus was dreaded as the agent of infection in newborns. An infectious mononucleosis-like disease with negative heterophil antibodies in otherwise healthy adults was described in 1965. We present six previously healthy adults with CMV mononucleosis observed in 1984. The diagnosis was established by CMV-IgM-ELISA. All patients were febrile for an average of 20 days. The general state of health was reduced in three patients; one patient suffered from headache and another from abdominal pain. Physical examination showed splenomegaly and mild tonsillitis in one patient each, but in no case lymphadenopathy. All patients had lymhocytosis with reactive forms (virocytes). Elevation of transaminases was seen in four cases. Compared to Epstein-Barr virus mononucleosis, fever in CMV mononucleosis lasts significantly longer and lymphadenopathy is evidently rarer. The combination of fever of unknown origin, a negative heterophil antibody titer and the presence of virocytes prompts suspicion of CMV mononucleosis.
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PMID:[Clinical aspects of cytomegalovirus infection in nonimmunosuppressed adults]. 301 71

Prompted by the case history of a 17 year old girl with anaemia, mononucleosis infectiosa and abdominal pain, paroxysmal nocturnal haemoglobinuria (PNH) is described. After a mononucleosis infectiosa infection she developed many complications of which the most prominent were hemolysis and thrombosis. Severe abdominal pain and episodic bowel obstruction occurred as a result of micro-infarction of the mesentery; bone marrow aplasia and lysis of platelets resulted in progressive thrombopenia. Pathogenesis and therapeutical possibilities are discussed. Coexistence of a necrotising enterocolitis with rectovaginal fistula, a heart infarction and the striking weight loss and hyponatremia during exacerbations, as seen in our patient, have not previously been described in PNH.
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PMID:[An adolescent with paroxysmal nocturnal hemoglobinuria]. 317 15

Several viral infections, including mumps, coxsackie B, and infectious mononucleosis, have been associated with acute pancreatitis; however, varicella infection has not previously been associated with this complication. A 29-year-old man was admitted to the hospital with severe abdominal pain and hyperamylasemia several days following the onset of a characteristic varicella skin rash. His son had been diagnosed with varicella one week earlier. The hospital course was complicated by the development of pseudocysts in the head and tail of the pancreas which caused partial obstruction of the common bile duct and duodenum. The pancreatitis, pseudocysts, and duodenal obstruction resolved with conservative medical management. This is the first report of acute pancreatitis associated with varicella infection.
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PMID:Varicella pancreatitis complicated by pancreatic pseudocyst and duodenal obstruction. 340 5

Spontaneous splenic rupture is a rare but life-threatening complication of infectious mononucleosis. Patients typically present with acute abdominal pain most marked in the left lower abdomen. Occasionally the pain is referred to the left shoulder and preceded by "flu-like" symptoms. Palor, orthostasis, and tachycardia can also be observed. Because abdominal pain and tachycardia are unusual in uncomplicated cases of infectious mononucleosis, the possibility of spontaneous splenic hematoma or rupture must be considered. The case presented here typifies the clinical manifestations of this entity and illustrates appropriate management.
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PMID:Spontaneous splenic rupture in infectious mononucleosis. 362 36

Male patients with the X-linked lymphoproliferative syndrome (XLP) have an inherited immune deficiency to Epstein-Barr virus (EBV) infection that results in fatal infectious mononucleosis (IM), acquired hypogammaglobulinemia- or agammaglobulinemia, virus-associated hemophagocytic syndrome, and non-Hodgkin's malignant lymphoma (ML). A clinicopathologic analysis of 17 patients with XLP who developed ML was performed. The median age of the patients at the time of diagnosis was 4.0 years (range, 2-19 years). The median overall survival was 12 months (range, 1-216 months). Eight patients had maternally related male relatives with ML. Other phenotypes of XLP were documented in male relatives of the remaining nine patients. Common presenting symptoms were fever, nausea, vomiting, and abdominal pain. Nine patients had "B" symptoms. All ML occurred at extranodal sites. The intestines, most commonly ileocecal, were involved in 76.5% of the cases. Thirteen patients had localized disease (Stages I and II) and four patients had advanced disease (Stages III and IV). A diffuse histologic pattern of growth was observed in all cases. The distribution of histologic subtypes included small noncleaved (41.2%), large noncleaved (17.6%), immunoblastic (17.6%), small cleaved or mixed cell (11.8%), and unclassifiable (5.9%) ML. Surgical resection, radiation therapy, and chemotherapy resulted in disease-free survivals of up to 192 months in eight patients (median 114 months; range, 12-192 months). Eight of 17 patients (47%) are still alive. A median survival of only 6.0 months (range, 1-12 months) was observed in the nine patients who died. No residual ML was found at autopsy. The small noncleaved subtype had an adverse prognosis (seven of nine deaths versus one of eight survivors; P less than 0.05). Bacterial infection was the major cause of death (seven of nine patients). Characteristics that distinguish ML in XLP from other ML include a maternal family history of XLP, early age of onset, acquired hypogammaglobulinemia, post-EBV infection, and ileocecal involvement.
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PMID:Malignant lymphoma in the X-linked lymphoproliferative syndrome. 381 12

We report a patient with icteric hepatitis and abdominal pain caused by Epstein-Barr virus in the absence of other common features of infectious mononucleosis. The peak alanine aminotransferase was 289 IU/I. Hemolytic anemia and urinary retention complicated the patient's course. Patients with infectious mononucleosis commonly have hepatic involvement but isolated symptomatic hepatitis is unusual. Although rare cases of liver failure have been reported, there is no evidence that Epstein Barr virus causes chronic liver disease. The clinical and histological features of Epstein Barr virus-induced hepatitis are reviewed.
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PMID:Epstein-Barr viral hepatitis: an unusual case and review of the literature. 608 55


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