Abstract

Infectious mononucleosis, most often caused by the Epstein-Barr virus (EBV), is a frequently encountered illness in emergency medical settings across the globe. One of the common findings associated with EBV infection is a temporary and usually mild elevation in liver enzymes, particularly transaminases. These abnormalities are typically subclinical and resolve on their own. However, a much less frequent but clinically significant complication is acute cholestatic hepatitis, presenting with signs of biliary flow obstruction. In such cases, patients may exhibit liver function test results that mimic those seen in obstructive jaundice. Notably, advanced imaging techniques, including ultrasound or MRI, often fail to reveal any mechanical obstruction within the biliary system. In this case report, we discuss an interesting case of hepatitis following EBV infection, the prompt emergency diagnosis and management and final outcome.

• 1.   Kang S.J., Yoon K.H., Hwang J.B. EpsteinBarr virus infection with acute pancreatitis associated with cholestatic hepatitis. Pediatr Gastroenterol Hepatol Nutr. 2013; 16(1): 61-4.
• 2.   Yesilbag Z., Kardeniz A., Kaya F.O. Acute acalculous cholecystitis: a rare presentation of primary Epstein-Barr virus infection in adults—Case report and review of the literature. Case Rep Infect Dis. 2017; 2017.
• 3.   Kimura H., Nagasaka T., Hoshino Y., et al. Severe hepatitis caused by Epstein-Barr virus without infection of hepatocytes. Hum Pathol. 2001; 32(7): 757-62.
• 4.   Salva I., Silva IV., Cunha F. Epstein-Barr virusassociated cholestatic hepatitis. BMJ Case Rep. 2013; 2013.
• 5.   Shaw N., Evans J. Liver failure and Epstein-Barr virus infection. Arch Dis Child. 1988; 63: 432-45.
• 6.   Vine L.J., Shepherd K., Hunter J.G., et al. Characteristics of Epstein–Barr virus hepatitis among patients with jaundice or acute hepatitis. Aliment Pharmacol Ther. 2012; 36(1): 16-21.
• 7.   Fugl A., Andersen C. Epstein-Barr virus and its association with disease—a review of relevance to general practice. BMC Fam Pract. 2019; 20(1): 62.
• 8.   Losavio A., Te H. Epstein-Barr virus: an unusual cause of cholestatic hepatitis in older adults. Gastroenterol Hepatol (N Y). 2007; 3(2): 101-5.
• 9.   Agergaard J., Larsen C. Acute acalculous cholecystitis in a patient with primary EpsteinBarr virus infection: a case report and literature review. Int J Infect Dis. 2015; 35: 67-72.
• 10.   Straus S.E., Cohen J.I., Tosato G., et al. EpsteinBarr virus infections: biology, pathogenesis and management. Ann Intern Med. 1993; 118(1): 45-58.
• 11.   Yang S.I., Geong J.H., Kim J.Y. Clinical characteristics of primary Epstein-Barr virus hepatitis with elevation of alkaline phosphatase and y-Glutamyltransferase in children. Yonsei Med J. 2014; 55(1): 107-12.
• 12.   Hinedi T.B., Koff R.S. Cholestatic hepatitis induced by Epstein-Barr virus infection in an adult. Dig Dis Sci. 2003; 48(3): 539-41. 13. Shaukat A., Tsai H., Rutherford R., et al. Epstein-Barr virus induced hepatitis: an important cause of cholestasis. Hepatol Res. 2005; 33(1): 24-6.

Data Sharing Statement

Funding