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Isolation of Neonatal Extrahepatic Cholangiocytes
Published on: June 5, 2014
Unusual Presentation of Epstein-Barr Virus-Associated Cholestatic Hepatitis in an Infant
Raafat Hammad Seroor Jadah1, Noor Mohamed Ghassan Shaikho1, Sara Abdulla Hasan1
1From the Department of Paediatrics, Bahrain Defence Force Royal Medical Services, Riffa, Bahrain.
Insights
Epstein-Barr virus (EBV) can cause severe acute cholestatic hepatitis in infants, presenting with significant liver enzyme elevation. This case highlights the importance of considering EBV in young children with unexplained hepatitis.
Area of Science:
- Pediatric Hepatology
- Virology
- Infectious Diseases
Background:
- Epstein-Barr virus (EBV) infections are common in children, usually presenting asymptomatically or with mild symptoms.
- Severe liver enzyme elevation is uncommon in acute EBV infections, typically not exceeding five times the upper limit of normal.
Observation:
- A 1-year-old girl presented with fever, vomiting, and diarrhea, progressing to jaundice, hepatomegaly, abdominal distension, and rash.
- Laboratory results showed markedly elevated transaminases (ALT 7,664.5 IU/L, AST 12,266 IU/L), elevated GGT (224 IU/L), and hyperbilirubinemia (total 130.7 µmol/L).
- Abdominal ultrasound revealed hepatomegaly with mild ascites; serology confirmed EBV infection.
Findings:
- The patient experienced a rapid and severe elevation of liver enzymes, indicative of acute cholestatic hepatitis.
- Diagnosis was confirmed by positive Monospot test and EBV immunoglobulin G antibodies.
- Supportive therapy led to clinical improvement within one week.
Implications:
- This case underscores the need to consider EBV as a potential cause of severe acute hepatitis in very young children.
- Early recognition and consideration of EBV are crucial for appropriate management of pediatric hepatitis.
- Highlights atypical presentations of common viral infections in pediatric populations.
Abstract:
Epstein-Barr virus (EBV) infections are prevalent in the pediatric population but are subclinical in the majority of cases. Elevated transaminases in the acute setting rarely increase beyond 5 times the normal upper limit. We present a girl aged 1 y with fever, vomiting, and diarrhea. Although initial physical examination was unremarkable, she developed jaundice, hepatomegaly, abdominal distension, and a maculopapular rash during admission. Laboratory investigations revealed marked increase in transaminases (alanine aminotransferase 7,664.5 IU/L, aspartate aminotransferase 12,266 IU/L), elevated γ-glutamyl transferase (224 IU/L), and hyperbilirubinemia (total 130.7 µmol/L, direct 104.9 µmol/L). Abdominal ultrasound reported hepatomegaly with mild ascites. Serology revealed that both Monospot test and EBV immunoglobulin G were positive. With supportive therapy, improvement was noted within a week of symptom onset. We hereby elucidate the importance of considering EBV as a cause of acute cholestatic hepatitis in a very young pediatric patient who develops a rapid elevation of liver enzymes.
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