An overlooked cause of hepatitis and thrombocytopenia with clinico-biochemical discrepancy: A case of infectious mononucleosis

Abstract

A 22-year-old male was admitted to the outpatient clinic with fatigue, fever, and a sore throat. High transaminase levels, moderate thrombocytopenia, and elevated acute phase reactants were detected ten times. Ultrasound imaging revealed hepatosplenomegaly and a peripheral blood smear showed Downey cells. Epstein-Barr virus (EBV) infection was considered the definite diagnosis, and EBV serology was performed. His mild clinic improved to normal within days, but the patient's clinical progression and laboratory findings were incompatible. Laboratory results were on the extreme side, while the clinic was mildly deteriorating. EBV viral capsid antigen IgM was high, supporting the initial diagnosis. Biochemical normalization followed clinical improvement many days later. Clinicians should know that EBV infection may be mild, while laboratory results illustrate extreme findings.