Asymptomatic EBV Infection may Uncover Ezetimibe Liver Alterations in a Hypercholesterolemic Child

Abstract

The Epstein Barr viral (EBV) infection may be associated with liver side-effects from ezetimibe treatment in children. An 11-year-old child with familial hypercholesterolemia (FH) presented with a normal biochemical liver profile before ezetimibe treatment, with no significant alterations of liver enzymes. Three months after beginning treatment with ezetimibe 10 mg/day, he complained of constant weakness, and blood testing revealed marked transaminase elevations. Administration of ezetimibe was stopped. However 15 days later alanine transferase (ALT) levels showed a further increase, followed, 10 days later, by an improvement in all pathological levels. After a further 2 months, all values had returned to normal. Tests for antibodies to the EBV were positive, suggesting a recent but not acute EBV infection. It was thus decided to test ezetimibe 10 mg/day again, and after 1 month aspartate aminotransferase (AST) and ALT levels were in a normal range, together with a very satisfactory LDL-cholesterol (LDL-C) response. This is the first report of a child with significant liver side-effects from ezetimibe treatment. Ezetimibe treatment may not have been the direct cause of liver damage in this child, because a concomitant EBV infection. Association of the two should be a warning for possible liver complications. doi: http://dx.doi.org/10.4021/jmc903w