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Epstein-Barr Virus Hepatitis Masquerading as Painless Jaundice
Anuoluwapo Adelodun1, Amro Abdellatief1, Oyedotun Babajide2
1Internal Medicine, Harlem Hospital Center, Columbia University, New York, USA.
Cureus
|November 21, 2022
Summary
Epstein-Barr virus (EBV) infection can cause painless jaundice and elevated liver enzymes. This case highlights EBV hepatitis as a rare but important diagnosis in adults when common causes are excluded.
Area of Science:
- Hepatology
- Infectious Diseases
- Virology
Background:
- Epstein-Barr virus (EBV) commonly causes infectious mononucleosis, typically with pharyngitis and mild liver enzyme elevations.
- Hepatitis, characterized by jaundice and elevated transaminases, is an uncommon presentation of EBV infection in adults.
Observation:
- A 27-year-old woman presented with painless jaundice and dark urine, with significantly elevated ALT and AST levels.
- Initial investigations ruled out common viral hepatitis (A, B, C) and biliary obstruction.
- EBV serology confirmed active infection.
Findings:
- The patient exhibited direct hyperbilirubinemia and marked transaminitis (ALT 1287U/L, AST 1057U/L) with normal alkaline phosphatase.
- Abdominal ultrasound showed no bile duct dilation, and hepatitis serologies were negative.
- EBV infection was identified as the cause of hepatitis.
Implications:
- This case underscores the importance of considering EBV hepatitis in the differential diagnosis of unexplained jaundice, particularly in immunocompetent adults.
- Early diagnosis via serological testing is crucial for appropriate management.
- Increased clinical suspicion for EBV-related liver injury can prevent delayed diagnosis and unnecessary investigations.
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