1. 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
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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 (2015).
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“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.”