Infección por el virus de Epstein-Barr y hepatitis aguda colestásica

Abstract

Epstein-Barr virus (EBV) is a herpesvirus whose only reservoir host is the human. It is transmitted by oropharyngeal secretions. Primary EBV infection is usually asymptomatic, but sometimes it causes infectious mononucleosis with fever, lymphadenopathies, splenomegaly and pharyngitis. Acute infection is diagnosed by serology (heterophile or specific antibodies). Immunofluorescence and molecular biologic techniques may be used to demonstrate the presence of EBV in biopsy specimens. Mild and transient elevations of serum aminotransferases are common, thus liver biopsy is usually not necessary to confirm the diagnosis. Severe cholestasis is rare (5%). We describe a patient with cholestatic hepatitis and acute EBV infection with atypical lymphocytes and positive anti-VCA IgM. The patient had taken drugs (ibuprofen, paracetamol and valerian). The bad evolution of the patient, the history of exposure to drugs, and the few cases of cholestatic hepatitis due to EBV infection reported, led us to consider liver biopsy. Molecular biologic techniques confirmed the presence of EBV in liver tissue however histologic features did not exclude the toxic aetiology or the concomitant effect of drugs and EBV infection.

Cholestatic Hepatitis Secondary to Epstein–Barr Virus Infection in Children: Case Series and Review of the Literature

“…[15][16][17] Although atypical presentations such as CH are frequent complications in adults, it is a rare clinical condition in children and adolescents. 3,4,18 Massei et al 7 found cholestasis in 5% of children with EBV infections over 3 years. The most frequent symptoms in children with EBV-induced CH were reported as jaundice and fever, followed by lymphadenopathy and pharyngitis.…”

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

“…Mechanisms of liver injuries related to EBV infections are not entirely clear, and include: products of immune responses to viral antigens (interferon γ, TNFα, Fas ligand), infected CD8+ T cells, and infiltrating cytotoxic T lymphocytes 10 , in addition to immunodeficiency syndromes, complement deficiency, X-linked lymphoproliferative disease, or treatment 8 . Because the prevalence of IM is very high worldwide 7,8,10 , there is a concern about possible under diagnosis, misdiagnosis, or underreporting of EBV-induced liver changes 8 . Although EBV-related acute hepatitis with jaundice has been scarcely reported, this condition may be under diagnosed in young patients 9 , because clinical and laboratory features (except for serology data) may be identical to that associated with the classic hepatotropic viruses 4 .…”

“…Chronic active infection and diverse malignancies have been associated with EBV, including gastric and nasopharyngeal carcinomas, Burkitt's and Hodgkin's lymphomas, and leukemia 1,4,5 . Classical features of IM are fever, pharingo-tonsilitis, lymph node enlargement, hepato-splenomegaly, and lymphocytosis with large number of atypical lymphocytes [6][7][8][9] . The wide spectrum of signs and symptoms of IM may pose diagnostic challenges, with under recognition or misdiagnosis.…”

Hepatitis Aguda Grave por Coinfeccion por Virus Epstein-barr y Citomegalovirus- reporte de caso y revisión de la literatura

“…La afectación hepática, con o sin hepatoesplenomegalia, se presenta en el 30-60% de los pacientes con aumento del AST y ALT, fosfatasas alcalinas (patognomónico) e incluso ictericia por aumento de la bilirrubina (1)(2)(3) , teniendo una presentación de menor severidad en niños que en adultos mayores de 30 años 2. La mayoría de casos de mononucleosis infecciosa cursan con una leve y autolimitada elevación del TGO y TGP (4) .…”

“…La identificación del virus de Epstein Barr se realiza mediante marcadores como los anticuerpos heterófilos (test de Paul-Bunnell), la determinación del antígeno nuclear del genoma viral, la presencia de linfocitos atípicos en sangre periférica y anticuerpos de tipo IgM (2,4) .…”