The patient's EBV PCR was positive. In combination with her flu like symptoms the diagnosis of infectious mononucleosis was made. The associated splenomegaly and subcapsular splenic hematoma caused hemoperitoneum dropping the hemoglobin to 83. The patient was transfused 1 unit of packed red blood cells, due to concern of ongoing losses and tachycardia. This case was managed conservatively.

The treatment of splenic hematoma includes a conservative watch and wait approach, endovascular embolization and splenectomy.