Sports medicine pearls and pitfalls — defending the spleen: Return to play after infectious mononucleosis

Abstract

Introduction: Defending the Spleen Recently, I spoke with a college football team physician on the sidelines before a game. He said their punter was out with infectious mononucleosis tiM) but was feeling better. Based in part on reviewing the recent literature, he was going to let the punter return to play at 3 weeks after the onset of illness. This reminded me of when the University of Oklahoma starting punter was out with IM, but by day 10 was feeling better and the coach wanted him back. I said, Not yet, Coach, explaining about the chance of splenic rupture. The coach replied, Not to worry, Doc, I'll put an extra blocker back for him. Return to play after IM can be a tough call that often hinges on defending the spleen. Controversy abounds. Patients must be individualized, and few physicians (or review authors) have had enough experience with the rare complication of splenic rupture to be experts. As I reviewed in 1996 [1], recommendations for return to contact sports after IM have ranged from 3 weeks to 3 months. Below, I summarize return to play guidelines from four recent reviews [2-5].