Intense pruritus in Epstein-Barr virus (EBV) hepatitis treated with naloxone drip

Abstract

Pruritus is a manifestation of chronic liver disease. Epstein-Barr virus (EBV) infection often presents as infectious mononucleosis and mild hepatitis. Severe pruritus in the setting of infectious mononucleosis and persistent marked hyperbilirubinaemia is exceedingly uncommon. To the best of our knowledge, we present the first case of a patient with EBV hepatitis and severe pruritus that was successfully treated with an ultra-low dose of intravenous naltraxone.

Acute Epstein-Barr virus hepatitis presenting clinically as ascending cholangitis in an immunocompetent patient

“…Liver function derangement during EBV infection usually occurs during the second week of infection, and resolves within 2-6 weeks. 5 Typically, the transaminases (ALT and AST) are affected and will rise up to five times the limit of normal. 6 Elevation of ALP and GGT is also common but is generally not associated with bilirubin rise.…”

“…18,19 From authors review of the literature, the majority of patients presenting with acute symptomatic EBV hepatitis, without infectious mononucleosis syndrome, have normal biliary tree imaging without dilation. 5,20,21 In one case report, a patient had a mildly dilated common bile duct at 9 mm and underwent ERCP to exclude biliary obstruction, which revealed no abnormality. 22 Differentiation of EBV infection from intrabdominal infection is important to avoid side-effects associated with misplaced antibiotic treatment.…”