More Than a Viral Syndrome

Cytomegalovirus (CMV) infection typically causes mild, a self-limited febrile illness in immunocompetent individuals. Although CMV is well-known for causing severe complications in immunocompromised patients, vascular complications such as splenic infarction remain exceedingly rare in healthy hosts. We report a 22-year-old immunocompetent woman who developed multiple splenic infarcts secondary to acute CMV infection. The patient presented with 3 weeks of fever, fatigue, and abdominal pain. Laboratory findings revealed atypical lymphocytosis and elevated transaminases. Computed tomography imaging demonstrated splenomegaly with characteristic wedge-shaped hypodense areas consistent with splenic infarction. Extensive workup excluded other etiologies, including hypercoagulable disorders, embolic sources, and alternative causes. CMV viremia was confirmed with polymerase chain reaction and elevated antibodies. The patient recovered with supportive care without antiviral therapy. This case highlights CMV as a potential etiology of splenic infarction in immunocompetent patients and emphasizes the importance of considering CMV in the differential diagnosis of febrile illness with splenic involvement.