IDDF2019-ABS-0020 Acute cholestatic hepatitis induced by epstein-barr virus infection in an adult

Abstract

Background Acute cholestatic hepatitis without features of infectious mononucleosis is a rare presentation of primary Epstein-Barr virus(EBV) infection, with only several cases previously reported in the medical literature. Methods A 24 years old young man with a febrile illness was noted to have a cholestatic picture of deranged liver function tests. Over the following week, progressive obstructive jaundice developed, with no evidence of choledocholithiasis on ultrasound and magnetic resonance cholangiopancreatography. Serological tests for hepatitis A, B, C, E, cytomegalovirus (CMV), leptospirosis were negative. Specific immunoglobulin M antibodies against EBV were detected in his serum and the diagnosis of EBV associated hepatitis was confirmed by polymerase chain reaction testing. Results Supportive treatment was implemented and his liver function had normalized 3 months after presentation. Conclusions EBV is associated with a wide variety of clinical manifestations and can present as cholestatic hepatitis with or without features of infectious mononucleosis. While the diagnosis is often suggested by serological testing, EBV polymerase chain reaction is a new non-invasive laboratory study that can help identify infection in cases where the clinical presentation is atypical. Early investigation for EBV in febrile patients with deranged liver function tests and no demonstrable biliary obstruction on imaging can expedite both diagnosis and treatment, thereby avoiding costly or invasive procedures such as liver biopsy.