Introduction: Spontaneous splenic rupture is a rare occurrence in primary cytomegalovirus infection.
Cases: We report two cases of spontaneous rupture of the spleen associated with primary cytomegalovirus infection in young immunocompetent adults. One patient had iron deficiency anemia, and the other a pyruvate kinase deficiency. Nonoperative management was successful in both cases.
Discussion: Nine other cases identified by a search of the medical literature are also reviewed. These cases do not show evidence of any particular risk factor.