Ascites and severe hepatitis complicating Epstein-Barr infection

Area of Science:

• Hepatology
• Infectious Diseases
• Virology

Background:

• Epstein-Barr virus (EBV) infection is highly prevalent, typically causing mild symptoms.
• Severe hepatitis is a rare complication of EBV infection.
• Ascites complicating EBV infection has been reported infrequently, with prior cases lacking clear exclusion of other causes.

Observation:

• A 37-year-old male presented with symptoms of upper respiratory tract infection, progressing to jaundice, right upper quadrant pain, and tense ascites.
• Laboratory tests revealed significantly elevated liver enzymes (transaminases >5000 IU/L), high total bilirubin (18.0 mg/dL), prolonged prothrombin time (24.5 s), and a low serum-ascitic albumin gradient (0.3 g/dL).
• Diagnostic workup confirmed EBV infection with high IgG and IgM titers, while other viral pathogens were excluded.

Findings:

• This case represents the first documented instance of ascites complicating EBV infection in the absence of other identifiable causes of hepatic dysfunction.
• The findings highlight a narrow serum-ascitic albumin gradient as a characteristic feature in such cases.
• The patient demonstrated a complete clinical and laboratory recovery within six months.

Implications:

• This study expands the understanding of rare, severe complications associated with Epstein-Barr virus infection.
• It underscores the importance of considering EBV as a potential cause of hepatitis with ascites, even in the absence of typical risk factors.
• The successful recovery with supportive care suggests a favorable prognosis for this rare manifestation of EBV infection.