Cholestatic Hepatitis Induced by Epstein-Barr Virus in a Pediatric Population

Shkalim-Zemer, Vered; Shahar-Nissan, Keren; Ashkenazi‐Hoffnung, Liat; Amir, Jacob; Bilavsky, Efraim

doi:10.1177/0009922815570618

Cited by 24 publications

(42 citation statements)

References 21 publications

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“…7 Cholestatic hepatitis is a rare sequelae of EBV, and jaundice is seldom reported; however, it is more frequent in people aged 35 and older. 12,13,14 If seen, jaundice may be due to autoimmune hemolytic anemia, cholestasis due to acalculous cholecystitis, biliary duct obstruction due to abdominal lymphadenopathy, or cholestatic hepatitis. 9,15 The pathogenesis of cholestatic hepatitis due to EBV is unclear.…”

Section: Discussionmentioning

confidence: 99%

Epstein-Barr Virus-induced Jaundice

Herold

Grimaldo

2020

Clinical Practice and Cases in Emergency Medicine

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Infectious mononucleosis is primarily caused by Epstein-Barr virus (EBV) and is a common diagnosis made in emergency departments worldwide. Subclinical and transient transaminase elevations are a well-established sequela of EBV. However, acute cholestatic hepatitis is a rare complication. EBV infection should be considered as part of the differential diagnosis in patients with an obstructive pattern on liver function tests without evidence of biliary obstruction demonstrated on advanced imaging.

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Section: Discussionmentioning

confidence: 99%

Epstein-Barr Virus-induced Jaundice

Herold

Grimaldo

2020

Clinical Practice and Cases in Emergency Medicine

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“…16,17 Studies of pediatric cases of EBV hepatitis revealed gallbladder wall thickening in 45-50%. 18,19 From authors review of the literature, the majority of patients presenting with acute symptomatic EBV hepatitis, without infectious mononucleosis syndrome, have normal biliary tree imaging without dilation. 5,20,21 In one case report, a patient had a mildly dilated common bile duct at 9 mm and underwent ERCP to exclude biliary obstruction, which revealed no abnormality.…”

Section: Discussionmentioning

confidence: 99%

Acute Epstein-Barr virus hepatitis presenting clinically as ascending cholangitis in an immunocompetent patient

Colbran

2020

Int Surg J

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Symptomatic acute Epstein-Barr virus (EBV) hepatitis, without associated infectious mononucleosis syndrome, is exceptionally rare. A 30-year-old female presented to hospital with jaundice, fevers, and right upper quadrant abdominal pain. Her blood tests demonstrated marked hyperbilirubinemia and mild global liver function test abnormalities consistent with obstructive jaundice. Preliminary imaging with ultrasound showed gallbladder wall thickening and cholelithiasis, suggestive of potential cholecystitis. Authors were concerned for potential ascending cholangitis in the setting of her hyperbilirubinemia. The diagnosis was refuted after magnetic resonance cholangiopancreatography demonstrated no choledocholithiasis. A hepatic panel was performed which revealed positive EBV IgM serology. This case highlights the importance of considering EBV hepatitis as a potential differential diagnosis in patients with right upper quadrant pain, fevers and jaundice in the absence of an obstructing cause.

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“…O VEB é um agente infecioso muito comum na população pediátrica, afetando por ano cerca de 345 -671/100 000 adolescentes. 7 A manifestação clínica clássica neste grupo etário é a MNI, 3,6,8,10 podendo surgir com outros sinais e sintomas como esplenomegália (> 50%), hepatomegália (30% -50%) e exantema (5%, 90% -100% nos casos tratados com ampicilina). 2 A icterícia, por sua vez, é uma manifestação rara da infeção a VEB, estando descrita em menos de 5% dos doentes em idade pediátrica.…”

Section: Discussionunclassified

“…2 A gravidade da sintomatologia está relacionada com a resposta imunológica, sendo a infeção habitualmente subclínica durante a infância e francamente sintomática durante a adolescência. 1,[4][5][6][7] Neste grupo etário pode manifestar-se como mononucleose infeciosa (MNI). 5,8 Inicialmente, existe um período prodrómico com astenia, anorexia e mialgias, e pode observar-se esplenomegália e/ou hepatomegália.…”

Section: Introductionunclassified

Mononucleose Infeciosa e Hepatite Colestática: Uma Associação Rara

Salgado¹,

García

Rúbio

et al. 2017

Acta Med Port

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Infectious mononucleosis is one of the major clinical manifestations of Epstein-Barr virus infection. In this syndrome, elevation of liver transaminase levels is common but cholestasis is rare, with few cases described in the literature. We present the case of a 14-year-old female adolescent, admitted to the Emergency Room with fever, odynophagia and cervical adenomegaly. She was treated with amoxicillin and two days later he presented with jaundice. The analytical evaluation was compatible with cholestatic hepatitis and abdominal ultrasound revealed hepatosplenomegaly without dilatation of the bile ducts. The diagnosis of Epstein-Barr virus infection was confirmed by the presence of serological markers. This case aims to raise awareness of a rare manifestation of a common infectious agent and, consequently, to the inclusion of acute Epstein-Barr virus infection in the differential diagnosis of pediatric cholestatic hepatitis.

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Cholestatic Hepatitis Induced by Epstein-Barr Virus in a Pediatric Population

Abstract: EBV infection should be included in the differential diagnosis of CH in all age groups. In the vast majority, full recovery is expected.

Cited by 24 publications

References 21 publications

Epstein-Barr Virus-induced Jaundice

Epstein-Barr Virus-induced Jaundice

Acute Epstein-Barr virus hepatitis presenting clinically as ascending cholangitis in an immunocompetent patient

Mononucleose Infeciosa e Hepatite Colestática: Uma Associação Rara

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