Epstein-Barr virus induced acute hepatitis with hyperferritinemia: A rare presentation

Area of Science:

• Hepatology
• Virology
• Immunology

Background:

• Primary Epstein-Barr Virus (EBV) infection commonly presents with elevated liver enzymes and bilirubin, typically subclinical and self-limiting in adults and children.
• EBV-induced hepatitis is a rare cause of acute hepatitis, accounting for less than 1% of cases, and predominantly affects immunocompromised individuals and those over 60.
• Elevated ferritin levels are linked to EBV infection severity and complications like autoimmune hemolytic anemia and hemophagocytic lymphohistiocytosis.

Observation:

• This report details a rare case of isolated acute cholestatic hepatitis caused by Epstein-Barr Virus (EBV).
• The patient was an immunocompetent adult, presenting with hyperferritinemia and cholestatic liver injury.
• The presentation was characterized by cholestasis, an uncommon feature of EBV hepatitis.

Findings:

• The case demonstrates an unusual presentation of EBV hepatitis with a cholestatic pattern.
• Significant hyperferritinemia was observed, correlating with the severity of liver injury.
• This contrasts with typical EBV hepatitis presentations, which are usually hepatocellular.

Implications:

• This case expands the spectrum of clinical presentations for Epstein-Barr Virus (EBV) hepatitis.
• It underscores the importance of considering EBV in the differential diagnosis of acute cholestatic hepatitis, even in immunocompetent adults.
• Further research may elucidate the mechanisms behind isolated cholestatic EBV hepatitis and hyperferritinemia.