Infectious mononucleosis, ruptured spleen and Cullen's sign.

Although Cullen' s sign is usually associated with haemorrhagic pancreatitis, this report describes a case in which it occurred in a patient with infectious mononucleosis and non-traumatic rupture of the spleen. Thomas Stephen Cullen (1869-1953) professor of gynaecology at Johns Hopkins University Hospital, Baltimore USA, gave his name to a peri-umbilical ecchymosis resulting from a haemoperitoneum secondary to the rupture of an ectopic pregnancy. Over the years, it has usually been considered to be a sign of haemorrhagic pancreatitis, but it has also been associated with other conditions.' Although a similar case has been published,2 we feel that its occurrence is rare enough to warrant mention, particularly in view of the opinion in a wellknown medical text book that Cullen's sign is so infrequent in splenic rupture that it is academic,3 and a later (17th) edition does not make any mention of an association.