MIXED PATTERN HEPATITIS: A RARE CONSEQUENCE OF INFECTIOUS MONONUCELOSIS Cynthia Philip MD, Christie Joya DO, Roseanne Ressner DO Department of Internal Medicine; Walter Reed National Military Medical Center, Bethesda, MD INTRODUCTION Epstein Barr virus (EBV) infections can present with fever, pharyngtonsillitis, lymphadenopathy, fatigue and a self limited increase in transaminase values. Transaminase levels are typically less than five times the upper limit of normal levels. Cholestatic hepatitis is rare and is seen in 5% of cases. Scleral icterus CASE DISCUSSION Jaundice in mononucleosis syndrome may be due to autoimmune hemolytic anemia, cholestasis due to acalculous cholecystitis, biliary duct obstruction, cholestatic hepatitis but the mechanism is unknown. Our patient had thrombocytopenia and coagulopathy which were further evidence of liver dysfunction. There have been rare cases reported of acalculous cholecystitis and fulminant hepatic failure. Exudative tonsillar adenopathy CONCLUSION It is important to consider EBV in the differential for cholestatic hepatitis to avoid unnecessary testing Close monitoring during the clinical course is important because a few patients may develop acute liver failure In the absence of immunodeficiency, we recommend supportive treatment. RESOURCES CT demonstrates splenomegaly 1) Agergaard, J., and C.s. Larsen. "Acute Acalculous Cholecystitis in a Patient with PrimaryEpstein-Barr Virus Infection: A Case Report and Literature Review." International Journal ofInfectious Diseases 35 (2015): 67-72. 2) Busch, Daniel, Sarah Hilswicht, Dominik S. Schöb, Klaus T Von Trotha, Karsten Junge,Nikolaus Gassler, Son Truong, Ulf P. Neumann, and Marcel Binnebösel. "Fulminant Epstein-Barr Virus - Infectious Mononucleosis in an Adult with Liver Failure, SplenicRupture, and Spontaneous Esophageal Bleeding with Ensuing Esophageal Necrosis: A Case Report." J Med Case Rep Journal of Medical Case Reports 8.1 (2014): 35. 4) Tan, Zh, Kb Phua, C. Ong, and A. Kader. "Prolonged Hepatitis and Jaundice: A Rare Complication of Paediatric Epstein-Barr Virus Infection." Singapore Medical Journal Smedj 56.07 (2015). 3) Salva, I., I. V. Silva, and F. Cunha. "Epstein-Barr Virus-associated Cholestatic Hepatitis."Case Reports 2013.Dec16 1 (2013). “The views expressed in this presentation are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of the Navy, the Department of Defense, nor the US Government.”