Acute hepatitis due to infectious mononucleosis in a 21-year-old-man

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.

Cytolytic hypertransaminasemia and cholestasis in patients diagnosed with infectious mononucleosis by the Epstein-Barr virus: Review of cases between 2016 and 2023

“…Finding transaminase elevation figures greater than x5N is not so common [3], although there are series with elevations of x10N in 60% of cases [7]. It is more rare to find cases of frank elevation of bilirubin, although there are series that report discrete increases in up to >40% of patients [1,9].…”

“…Liver involvement in IMN is found in around 90% of cases [5,[7][8][9][10], and is normally characterized by a mild and self-limited elevation of transaminases [2][3][4]9]. Cases of elevated bilirubin are rare, as are those of frank hepatitis [3,4,7,[9][10][11].…”

“…Liver involvement in IMN is found in around 90% of cases [5,[7][8][9][10], and is normally characterized by a mild and self-limited elevation of transaminases [2][3][4]9]. Cases of elevated bilirubin are rare, as are those of frank hepatitis [3,4,7,[9][10][11]. It can also present with: Abdominal pain, splenomegaly, hepatomegaly, asthenia, headache, arthralgia and, exceptionally, more serious complications [1,7,8].…”