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[Hepatitis by infectious mononucleosis]
V Albornoz1, E Wainstein, A Andrade
1Departamento de Medicina, Facultad de Medicina, Universidad de Chile, Santiago.
Abstract:
Five adult patients presenting with clinical and laboratory manifestations of an acute hepatitis in the course of a hitherto undiagnosed infectious mononucleosis (IM) are reviewed. Chief complaints were intense malaise and prolonged fever (7 to 15 days prior to diagnosis). Serum aminotransferases were moderately raised in all patients; three patients had mild jaundice with a direct-reacting hyperbilirubinemia; 4 patients had an enlarged and tender liver. When making the differential diagnosis of causes of acute hepatitis, blood smear examination was crucial, showing atypical lymphocytes (Downey). The diagnosis of IM was confirmed by the demonstration of high serum titers of antibodies against Epstein-Barr virus, IgM class (4 patients) or heterophil antibodies (1 patient), plus peripheral lymph node enlargement (3 patients), splenomegaly (4 patients) and the time course of the disease. The relevance of blood smear examination as a practical tool in the diagnosis of causes of acute hepatitis is stressed.
Insights
Infectious mononucleosis (IM) can present as acute hepatitis in adults. Blood smear examination is crucial for diagnosing IM-induced hepatitis by identifying atypical lymphocytes.
Area of Science:
- Hepatology
- Infectious Diseases
- Hematology
Background:
- Acute hepatitis necessitates a broad differential diagnosis.
- Infectious mononucleosis (IM) is a common viral illness often caused by Epstein-Barr virus (EBV).
- Hepatitis is a recognized, though less common, manifestation of IM.
Observation:
- Five adult patients presented with symptoms of acute hepatitis.
- Clinical signs included malaise, prolonged fever, hepatomegaly, and jaundice.
- Laboratory findings revealed elevated aminotransferases and hyperbilirubinemia.
Findings:
- Peripheral blood smear examination was critical, revealing atypical lymphocytes (Downey cells).
- Diagnosis of IM was confirmed by serological tests for EBV-specific antibodies (IgM) or heterophil antibodies.
- Associated findings included lymphadenopathy and splenomegaly.
Implications:
- Highlights the importance of considering IM in the differential diagnosis of acute hepatitis in adults.
- Emphasizes the diagnostic utility of peripheral blood smear analysis in identifying atypical lymphocytes.
- Suggests that early diagnosis of IM-induced hepatitis can guide appropriate patient management.