Successful plasmapheresis for extreme hyperbilirubinemia caused by acute Epstein-Barr virus

Epstein-Barr virus (EBV) infection can be complicated by cholestatic jaundice and hemolytic anemia, although both complications rarely occur simultaneously. An 18-year-old female developed acute EBV infection complicated by cold agglutinin hemolysis and cholestasis. Corticosteroid and ursodeoxycholic acid were initiated but bilirubin peaked at 1297.47 micromol/L (75.7 mg/dL). Plasmapheresis was initiated and with the corticosteroids, resulted in resolution of extreme hyperbilirubinemia. The patient recovered rapidly, is healthy 2 years later and is neurologically intact. The early use of plasmapheresis with corticosteroids and ursodeoxycholic should be considered in EBV infections complicated by extreme hyperbilirubinemia to prevent the rare complication of adult-onset kernicterus.