Severe acute hepatitis due to Epstein-Barr virus: A case report

Abstract

Infectious mononucleosis is caused in 90% of cases by the Epstein-Barr virus. Clinical manifestations are often mild and self-limiting. In pediatric patients, it is usually asymptomatic, and in adults, jaundice, lymphadenopathy, pharyngitis, and hepatosplenomegaly are the most common manifestations. The diagnosis is based on clinical suspicion and laboratory tests. Elevated liver function tests are typical due to systemic inflammation and invasion of the liver parenchyma by B cells infected with the Epstein-Barr virus. Positive serological tests indicating viral activity are also detected. We present the case of a 24-year-old male patient who consulted for fever, asthenia, adynamia, abdominal pain, and vomiting. Hepatobiliary function tests were elevated and rising, showing a mixed pattern of hepatocellular and cholestatic damage. Consequently, the differential diagnoses were expanded, and studies were performed to rule out viral, parasitic, intrahepatic, and biliary tract involvement, autoimmune, toxic, and Wilson's disease causes. The only positive result obtained was antibodies to the Epstein-Barr virus. Given that the patient's clinical condition showed no improvement and additional tests revealed severe liver dysfunction, severe acute hepatitis with coagulopathy was diagnosed, and treatment with N-acetylcysteine was initiated. Through a multidisciplinary approach, a satisfactory clinical recovery was achieved. This case highlights the importance of analyzing acute Epstein-Barr virus hepatitis as part of the differential diagnosis of acute viral hepatitis, evaluating its potential progression to acute liver failure.