Abstract
Infectious Mononucleosis (IM), a benign lymphoproliferative disease, is the best known clinical syndrome caused by Epstein-Barr Virus (EBV). It usually resolves over a period of weeks or months without sequelae but may occasionally be complicated by a wide variety of neurologic, hematologic, hepatic, respiratory, and psychological complications. In this report we describe a patient with acute hepatitis following EBV-IM in a previously healthy woman. A 26-year-old woman who presented with fever, generalized weakness, nausea, sore throat, yellowing of skin, and a generalized skin rash was admitted to our clinic. Tonsillar enlargement, pharyngeal erythema, palatal petechiae, lymphadenopathy, and jaundice were noted. Significant atypical lymphocytes ( > 10%) were seen on the peripheral blood smear. Liver function tests such as ALT: 303 U/L, AST: 172 U/L, ALP: 193 U/L and total bilirubin: 7.3 mg/dl were elevated. Serological tests for EBV infection were consistent with acute infection (EBV virus capsid antigen was reactive with IgM and IgG antibodies). The Monospot test was also positive. On the seventh day, liver function tests and bilirubin had risen to peak level and platelets were decreased. The patient was managed supportively and her critical condition improved and was finally stabilized. Although the prognosis for IM is very favorable, a variety of acute complications may occur.
Highlights
Infectious mononucleosis (IM) is a lymphoproliferative and an infectious disease caused by Epstein-Barr virus (EBV)
Infectious Mononucleosis is known as a benign, usually self-limiting, acute clinical presentation of EBV infection
In primary care practice, when there is a high level of viral upper-respiratory infections or group A streptococcal pharyngitis in the community, diagnosis of mild EBV infection is difficult if not impossible
Summary
Infectious mononucleosis (IM) is a lymphoproliferative and an infectious disease caused by Epstein-Barr virus (EBV). Case report A previously healthy 26-year-old woman who presented with a 10-day history of fever, generalized weakness, nausea, mild sore throat, yellowing and itching of the skin for three days, and a generalized skin rash was admitted to our clinic. There was no family history of liver disease and immunodeficiency Her history revealed use of amoxicillin-clavulanic acid for seven days for exudative tonsillopharyngitis. Tonsillar enlargement with membranous exudation, pharyngeal erythema, palatal petechiae, cervical and inguinal lymphadenopathy, scleral jaundice, and mild tenderness in the right upper quadrant were noted. Initial serological tests for EBV infection were consistent with acute infection (EBV virus capsid antigen [VCA] was IgM and IgG positive; Epstein-Barr nuclear antigen [EBNA] was negative). In view of the clinical and laboratory findings, we reached a conclusion of EBV infection as a cause of the acute hepatitis in this patient.
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