Ascites and Severe Hepatitis Complicating Epstein-Barr Infection

Abstract

Epstein-Barr (EB) virus infection is common, with up to 90% of individuals demonstrating positive titers by age 20. Although elevated liver function tests commonly occur, severe hepatitis is rare. Only six cases of ascites complicating Epstein-Barr infection are reported, but none clearly demonstrate the absence of other causes of hepatic dysfunction. A 37-yr-old male presented with a 4-wk history of upper respiratory tract symptoms. Over 3 days before admission he developed jaundice and right upper quadrant pain. After hospitalization, the patient developed tense ascites requiring paracentesis. Serum-ascitic albumin gradient was 0.3 g/dL. Liver function tests peaked at the following values: prothrombin time of 24.5 s, total bilirubin of 18.0 mg/dL, and transaminases in excess of 5000 IU/L. EB Virus IgG and IgM titers were 1:640 and >1:40, respectively. Other viral serologies and polymerase chain reactions were negative. The patient experienced a complete clinical and laboratory recovery over the next 6 months. This represents the first documentation of ascites complicating Epstein-Barr infection without other sources of hepatic dysfunction. It demonstrates a narrow serum-ascitic albumin gradient in these patients, and that complete recovery can occur with supportive care.

Correlates of Illness Severity in Infectious Mononucleosis

“…Hepatitis is known to be a complication of IM, although the magnitude is not well documented in prospective studies that incorporate viral load measurements. The condition is usually benign, but fulminant hepatitis has been documented (21,22). Our findings are similar to a prospective study by Rea et al (13), in which 31% and 61% of their patients had abnormal ALT and AST levels at their initial visits.…”

Treatment of Epstein‐Barr virus‐associated hemophagocytic lymphohistiocytosis (EBV‐HLH) in young adults: A report from the HLH studyl center

“…It should also be noted that some patients recovered well with supportive care or with conventional therapy. Not included in the analysis because of the older age (above 35 years), the case reported by Devereauz et al [15] is noteworthy, that patient with severe hepatitis and ascites recovered completely with supportive care alone over a period of 6 months. Furthermore, the case reported by van Laar et al [29], Case L9 in Table II, responded well to a combination of prednisolone and acyclovir.…”

“…These diseases now fall in the category of severe EBV-HLH [14]. Some EBV-HLH cases have also been reported as ''severe hepatitis or fulminant hepatic failure complicating EBV infection'' [15,16].…”

Sometimes double negative is positive

“…EBV and cytomegalovirus (CMV) infections may present with fever and diffuse lymphadenopathy with hepatitis, anemia, leukopenia, and thrombocytopenia (1)(2)(3)(4)(5). Despite the presence of some of these findings in our patient, these viral infections are quite rare in late adulthood.…”