Football players and infectious mononucleosis go together like oil on teflon. But a few weeks ago these two characters met in a duel. In one corner stood the formidable opponent – a 17yr old football hero, his brain is saying to get back into the game, his spleen is saying, "hold on there a minute, buddy." In the other corner – Mr.Mononucleosis, a lean mean spleen-rupturing machine. And the doctors in a small-town clinic in Berne got to play referee.

Two weeks ago our friend the football hero came down with a case of mono. He recovered quickly and presented to our clinic for a recheck. Examination revealed no lymphadenopathy, no splenic enlargement and a patient who was feeling great with no signs of fatigue. To his dismay, however, he was told that he was to stay away from contact sports but would be allowed to stand on the sidelines and engage in activities that did not involve any direct tackling/trauma. He agreed and all was said and done… until 3 days later. The night before his symptoms set he decided to go for a light jog to get back into shape for the upcoming sports season. The next morning he appeared in our office with severe 12/10 pain, guarding around his left quadrant, and an inability to lie flat on his back due to the extreme pain. We rushed him to Albany Med’s ER where a CT scan revealed splenic enlargement with no signs of rupture and normal labs. Diagnosis - ?. Treatment – fentanyl and an overnight admission to D7 for observation. Thankfully his spleen had not ruptured and was most likely causing pain by pressing against the abdominal wall. But how could a light jog have caused such symptoms? And what level of activity should we recommend for future patients recovering from a bout of mono?

Athletes do seem to recover quicker than non-athletes according to two studies comparing West-Point cadets to Yale undergraduates. (no offense to all you buff Yale grads) However, this may be a reflection of an enhanced desire or perceived need for the athletes to resume more strenuous activities than true recovery from the illness. Athletes, in general, should wait atleast 3-4 weeks from the onset of their illness to return to weightlifting or strenuous activity. Furthermore, if the athlete is going to engage in a high-risk, collision, or contact sport at such a time, radiologic evaluation of the spleen may be necessary. Simple absence of splenic enlargement on abdominal palpation may not be enough.

Such guidelines beg the question of whether light jogging would fit under the category of "strenuous activity." Currently our patient is recovering and has not had any more complications. He was discharged the following day and sent home with pain medications. Lucky for him he did not experience a splenic rupture—a situation presenting with a grave prognosis due to the highly vascular nature of the spleen. As for football season, unfortunately our patient will be cheering in the stands rather than playing on the field this year.