Infectious Mononucleosis Hepatitis in Young Adults: Two Case Reports

Abstract

Infectious mononucleosis due to Epstein-Barr virus (EBV) infection sometimes causes acute hepatitis, which is usually self-limiting with mildly elevated transaminases, but rarely with jaundice. Primary EBV infection in children is usually asymptomatic, but in a small number of healthy individuals, typically young adults, EBV infection results in a clinical syndrome of infectious mononucleosis with hepatitis, with typical symptoms of fever, pharyngitis, lymphadenopathy, and hepatosplenomegaly. EBV is rather uncommonly confirmed as an etiologic agent of acute hepatitis in adults. Here, we report two cases: the first case with acute hepatitis secondary to infectious mononucleosis and a second case, with acute hepatitis secondary to infectious mononucleosis concomitantly infected with hepatitis A. Both cases involved young adults presenting with fever, pharyngitis, lymphadenopathy, hepatosplenomegaly, and atypical lymphocytosis confirmed by serologic tests, liver biopsy and electron microscopic study.

Characteristics of Epstein–Barr virus hepatitis among patients with jaundice or acute hepatitis

“…These findings are in agreement with previous studies which show that, although abnormal liver function tests occur in up to 80% of patients with EBV infection, symptomatic hepatitis is uncommon . In contrast to most of the existing literature which describes EBV hepatitis in children and young adults, our findings suggest that EBV hepatitis can occur at any age, including the elderly.…”

“…The majority of EBV infections occur in childhood and are asymptomatic. Symptomatic disease most commonly presents in young adults with the classic triad of fever, sore throat and lymphadenopathy, known as infectious mononucleosis . It is normally a benign and self‐limiting illness.…”

The levels of liver enzymes and atypical lymphocytes are higher in youth patients with infectious mononucleosis than in preschool children

“…The mechanism of liver involvement in IM patients was unclear, much less in the discrepancy between different age group. CD3 positive T lymphocytes were identified as the main lymphocytic infiltrate in EBV hepatitis, which were mainly cytotoxic CD8 positive T lymphocytes 18-20. Several studies have shown increased level of inflammatory cytokines in the sera of IM patients 10,21.…”

Infectious mononucleosis with pleural effusion due to Epstein-Barr virus

“…[6,8] Tek taraflı ve iki taraflı efüzyon yaklaşık olarak eşit sıklıkta görülmektedir. Literatürde enfeksiyoz mononükleoz komplikasyonu olarak pulmoner efüzyon gelişen 12 olgu sunulmuş-tur.…”

“…[5] Primer EBV enfeksiyonunda hepatit genellikle orta derecede seyretmektedir. [6] Pulmoner tutulum hastalarda bilinen bir komplikasyon iken, plevral efüzyon nadirdir. [7] Olgu Sunumu…”