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A 22-year-old man was admitted to our hospital with a 3-day history of left upper quadrant abdominal pain. Five days prior to admission, he had continuous fatigue, fever, and sore throat lasting for 1 week. Laboratory studies on admission showed a white blood cell count of 6,240/μL (normal range, 3,210 to 9,680) with 51% lymphocytes, 8% of which were atypical. A contrast-enhanced ultrasound sonography using Sonazoid (perfluorobutane; Daiichi Sankyo, Tokyo, Japan) revealed an enlarged spleen with hypoechoic wedgeshaped areas with absence of blood flow (Fig. 1A and 1B). A computed tomography (CT) scan of the abdomen revealed splenic enlargement with splenic inSplenic infarction associated with acute infectious mononucleosis