Epstein-Barr virus-associated cholestatic hepatitis

Abstract

Epstein-Barr virus infection is common in children, usually presenting as infectious mononucleosis, including fever, tonsillitis and lymphadenopathy associated with self-resolving increase in transaminases. Cholestasis is rare in children with only a few cases reported but it was described in up to 55% of the adult population affected. We present a case of a 6-year-old boy with fever, vomiting and choluria. The physical examination showed hepatomegaly and jaundice and was otherwise unremarkable. The laboratory studies revealed increased transaminases (aspartate aminotransferase 97 U/L, alanine aminotransferase 166 U/L), hyperbilirubinaemia (total bilirubin 3.2 mg/dL, direct bilirubin 2.89 mg/dL) and increased γ-glutamyl transpeptidase (114 mg/dL). Urine urobilinogen was increased. The abdominal ultrasound showed hepatomegaly. Epstein-Barr viral capsid antibody IgM was positive and IgG was negative. Serological studies for other viruses were negative. We underline the need to consider Epstein-Barr virus in the cholestatic hepatitis differential diagnosis, in order to avoid unnecessary investigations.

Стан Антивірусного Імунітету У Хворих На Неалкогольний Стеатогепатит Учасників Ліквідації Аварії На Чорнобильській АЕС

“…Так, при інфекції Епштейна -Барр це може проявлятися помірним транзиторним підвищенням рівня печінкових ферментів [5], розви-тком холестатичного гепатиту [6] і навіть гострої печін-кової недостатності [7]. Також існує потенційний ри-Стан антивірусного імунітету у хворих на неалкогольний стеатогепатит учасників ліквідації аварії на Чорнобильській АЕС …”

Epstein-Barr Virus-induced Jaundice

“…1,2 However, significant cholestasis and jaundice are rare complications with an incidence of less than 5%. 3,4,5…”

Mononucleose Infeciosa e Hepatite Colestática: Uma Associação Rara

“…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.…”

“…1,4 O envolvimento hepático é frequente e traduz--se, habitualmente, pela elevação ligeira e autolimitada das aminotransferases. 4,7 A colestase embora não rara nos adultos, está descrita esporadicamente na população pediátrica. 5,7,9…”