Acute hepatitis due to infectious mononucleosis in a 21-year-old-man

Resumen

A 21-year-old male was admitted presenting with fever, fatigue, headache, pharingitis, abdominal pain, loss of appetite, vomiting and dark urine for three days. The patient denied recent use of medicines or any other drug. His physical examination disclosed jaundice, hepato-splenomegaly, whitish-yellow covered tonsils, bilateral anterior and posterior cervical lymph node enlargement associated with edema on the face and neck. Routine blood tests showed changes of bilirubins and of liver enzymes (total bilirubin: 14.5 mg/dl, direct bilirubin: 12.9 mg/dl, AST: 697 U/l, ALT: 619 U/l, alkaline phosphatase: 260 U/l, and gama GT: 413 U/l). Serological tests showed negative results for viral hepatitis, cytomegalovirus, HIV-1 and HIV-2, and toxoplasmosis; while the serology for recent infection by EBV was positive (IgM: 70 and 29 U/ml; EBV IgG: 25 and 156 U/ml). Although infrequently, EBV infection can cause acute hepatitis with accentuated cholestatic jaundice (5% of cases), which may constitute an additional diagnostic challenge for primary care workers. The patient improved with supportive management and was discharged to home after 12 days. This case study might contribute to increase the suspicion index about acute hepatitis related to EBV.