Abstract
Epstein - Barr virus (EBV) induced hepatitis and subsequent hyperbilirubinemia is a strikingly rare cause of jaundice. Lack of other common infectious mononucleosis symptoms makes the diagnosis difficult with history and physical exam alone. With differential diagnoses more commonly including HAV, HCV, and HBV hepatitis infections; alcoholic hepatitis; autoimmune hepatitis; and hepatocellular carcinoma, suspicion for EBV induced hepatitis is often low. We present a noteworthy case of isolated hyperbilirubinemia due to EBV virus confirmed with biopsy, without other infectious mononucleosis symptoms such as fever, sore throat, or splenomegaly. Furthermore, we review the pathophysiology, diagnosis, treatment, and prognosis of EBV-induced hepatitis.
Highlights
Epstein - Barr virus (EBV) is transmitted primarily from person-to-person contact via saliva [1]
Serology for EBV was positive for EBV VCA IgM >1:20
According to Vine et al, hepatitis due to EBV is selflimiting with the resolution of the viral infection
Summary
EBV is transmitted primarily from person-to-person contact via saliva [1]. Once in the saliva, EBV replicates in B-cell rich lymphocytic tissue in the oropharynx and disseminates lymphatically throughout the body and to the liver [2]. HBsAg, Anti-HAV IgM, Anti-HCV IgM, Anti-HEV IgM were all unremarkable. Ultrasound of the abdomen was negative for gallstones or CBD dilation, but CT-abdomen without contrast showed hepatic steatosis. MRCP and CT-chest/abdomen/pelvis with IV contrast were done, and were unremarkable.
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