EBV infection as a rare cause of acute cholestatic hepatitis: A case report

Abstract

Epstein-Barr virus (EBV) is a common herpesvirus, often presenting as infectious mononucleosis. While mild hepatic enzyme elevations are common in EBV infection, cholestatic hepatitis with significant hyperbilirubinemia is rare, occurring in less than 5% of cases. A 21-year-old female presented with epigastric pain and elevated liver enzymes with cholestatic pattern. Imaging excluded biliary obstruction. Serologic testing confirmed acute EBV infection. Other viral and autoimmune causes were ruled out. The patient improved with supportive care and was discharged. Although uncommon, EBV should be considered in the differential diagnosis of cholestatic hepatitis, particularly in young adults. Timely recognition may prevent unnecessary invasive procedures and ensure appropriate management.

Keywords

• ebstein-barr virus
• cholestatic hepatitis
• infectious mononucleosis

References

1. Bennett JE, Blaser MJ, Dolin R. Epstein-Barr virus (infectious mononucleosis, Epstein-Barr virus-associated malignant diseases, and other diseases). In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Vol. 2. Elsevier; 2019. p. 1754-1770.
2. Da Cunha T, Mago S, Bath RK, Bath R. Epstein-Barr virus reactivation causing cholestatic hepatitis. Cureus. 2022;14(4):e24325.
3. Mellinger J, Rossaro L, Naugler W, et al. Epstein-Barr virus-related acute liver failure: a case series from the US Acute Liver Failure Study Group. Dig Dis Sci. 2014;59(7):1630-7.
4. Fugl A, Andersen CL. Epstein-Barr virus and its association with disease: a review of relevance to general practice. BMC Fam Pract. 2019;20(1):62.
5. Rutkowska M, Pokorska-Śpiewak M. Epstein Barr Virus Hepatitis—A Mild Clinical Symptom or a Threat?. Vaccines (Basel). 2023;11(6):1119.
6. Khoo A. Acute cholestatic hepatitis induced by Epstein-Barr virus infection in an adult: A case report. J Med Case Rep. 2016;10:75.
7. Solomay TV, Semenenko TA, Ivanova MY. The role of Epstein-Barr viral infection and hepatitis B and C in liver pathology. Probl Virol. 2019;64(5):215-20.
8. Damania B, Kenney SC, Raab-Traub N. Epstein-Barr virus: Biology and clinical disease. Cell. 2022;185(20):3652-7