Hepatocellular jaundice in SARS-CoV-2 and EBV coinfection: a case report

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Epstein-Barr virus (EBV) are each individually associated with mild hepatic injury and, rarely, with hyperbilirubinemia. Coinfection is not well documented, and within available reports, mild hepatic injury has been demonstrated.

A 25-year-old man with no significant past medical history acquired coinfection and developed transaminitis, moderate hyperbilirubinemia, and hepatosplenomegaly. The degree of transaminitis was severe and out of proportion for either SARS-CoV-2 or EBV infection. The patient was admitted to the hospital for further laboratory and imaging studies to rule out other etiologies. He was managed symptomatically and without antiviral medications. The patient's transaminase levels demonstrated a pattern of recovery on day 10 with complete normalization documented at 10 months. There were no long-term sequelae.

While SARS-CoV-2 and EBV are each independently associated with mild hepatic injury, this case highlights a rare presentation of severe liver injury, possibly due to synergistic viral effects.