Abstract
A 21-year-old mole was admitted because of fever, fatigue, headache, pharyngitis, abdominal pain, loss of appetite, vomiting and dark urine for three days. The patient denied recent use of medicines or any other drug. His physical examination disclosed jaundice, hepato-splenomegaly, whitish-yellow covered tonsils, bilateral anterior and posterior cervical lymph node enlargement associated with edema on the face and neck. Routine blood tests detected abnormalities in serum bilirubins and liver enzymes (total bilirubin: 14.5 mg/dl, direct-reacting bilirubin: 12.9 mg/dl, AST: 697 U/l, ALT: 619 U/l, alkaline phosphatases: 260 U/l, and GGT: 413 U/l). Serological tests showed negative results for viral hepatitis, cytomegalovirus, HIV-1 and HIV-2, and toxoplasmosis markers, while serology for recent infection by EBV was positive (IgM: 70 and 29 U/ml; EBV IgG: 25 and 156 U/ml). Although infrequently, EBV infection can cause acute hepatitis with accentuated cholestatic jaundice (5% of cases), which may constitute an additional diagnostic challenge for primary care physicians. The patient improved with supportive management and was discharged after 12 days. This case study might contribute to increase the suspicion index about acute hepatitis related to EBV.
Highlights
A 21-year-old male was admitted because of fever, fatigue, headache, pharyngitis, abdominal pain, loss of appetite, vomiting and dark urine for three days
Mechanisms of liver injuries related to Epstein-Barr virus (EBV) infections are not entirely clear, and include: products of immune responses to viral antigens, infected CD8+ T cells, and infiltrating cytotoxic T lymphocytes[10], in addition to immunodeficiency syndromes, complement deficiency, X-linked lymphoproliferative disease, or treatment[8]
EBV-related acute hepatitis with jaundice has been scarcely reported, this condition may be under diagnosed in young patients[9], because clinical and laboratory features may be identical to that associated with the classic hepatotropic viruses[4]
Summary
A 21-year-old male was admitted because of fever, fatigue, headache, pharyngitis, abdominal pain, loss of appetite, vomiting and dark urine for three days. IM can cause mild to moderate elevations of direct-reacting bilirubin and aminotransferases, and deep jaundice due to direct-reacting hyperbilirubinemia is an uncommon finding in the course of primary EBV infections in immunocompetent young adults[1,7,8,9,10]. Laboratory findings are showed, characterizing an acute hepatitis associated with a recent infection by EBV.
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