S3520 Epstein-Barr Virus-Induced Acute Hepatitis

Abstract

INTRODUCTION: Epstein-Barr virus (EBV) is a causative agent of infectious mononucleosis syndrome in young adults. It causes asymptomatic liver-associated enzyme abnormalities in 80 to 90% of cases which are often unrecognized. Jaundice might rarely develop during the clinical course which likely reflects either more severe hepatitis or Epstein-Barr virus infection-associated hemolytic anemia. We report a case of EBV induced acute hepatitis. CASE DESCRIPTION/METHODS: A 28-year-old male with a past medical history of gastroesophageal reflux disease was admitted for yellow skin, nausea, fatigue, fever, and poor oral intake for the last five days. Abdominal exam was benign, but he was noted to have yellow skin and sclera. Blood work showed WBC 9.5 K/uL (lymphocytes 71%), Hb 16.9 g/dL, creatinine 1.0 mg/dL, albumin 3.9 g/dL, AST 541 U/L, ALT 743 U/L, alkaline phosphatase 684 U/L, total bilirubin 12.9 mg/dL with direct bilirubin 10.0 mg/dL. He had acute hepatitis work up like acute hepatitis panel, CMV, Blood culture, COVID-19, HIV, ANA, ASMA which were unremarkable. Ultrasound abdomen did not show gall bladder or biliary etiology. CT abdomen/pelvis showed splenomegaly with mild portal caval lymphadenopathy. He was found to have positive monospot and EBV PCR. He subsequently had a liver biopsy consistent with EBV positive lymphocytes. He was treated conservatively with good clinical improvement. DISCUSSION: Acute viral hepatitis in human can be caused by a variety of viruses with a wide range of clinical manifestations and laboratory findings. EBV is a rare causative agent of acute hepatitis, during the course of infectious mononucleosis. Hepatic manifestations of EBV are usually mild and resolve without serious complications. Treatment in these patients is supportive—namely to remain hydrated with an adequate electrolyte balance. Precautions to avoid contact sports are also important to emphasize, as there is a 0.1%–0.5 % risk of splenic rupture, which is fatal. This case highlights the importance of including EBV in the differential diagnosis of acute hepatitis in adults.