P3024 - Acute Hepatitis in a Pregnant 21-Year-Old Female: Unveiling the Impact of Acute EBV

Tiffany Wyatt, DO¹, Caleb M. Glover, DO², Maria Kim, BS³, Nicholas Diloreto, DO¹, Gisela Ocasio, DO¹, Dorian Jones, MD^1
1McLaren Greater Lansing Hospital, Lansing, MI; ²McLaren Greater Lansing Hospital, East Lansing, MI; ³Michigan State University, Lansing, MI

Introduction: Epstein-Barr Virus (EBV) is most commonly known for causing acute infectious mononucleosis with classic symptoms of fever, pharyngitis, lymphadenopathy, and splenomegaly. Liver involvement in primary EBV infection is often subclinical, generally presenting with transient transaminase elevations usually less than 5-fold normal limit. Jaundice is reported to occur in only 5-10% of cases. Complications with cholestatic involvement, severe hepatitis, or hepatic failure are rare manifestations of EBV infection, thus are infrequently described in literature.

Case Description/Methods: A 21-year-old pregnant female presented to the hospital's emergency department with complaint of jaundice and pruritic rash. She experienced headache, nasal congestion, sore throat, and a cough a week prior to her presentation. She had mild right upper quadrant abdominal pain 4 days prior to arrival but ultimately presented after developing jaundice and a pruritic rash covering her face, left shoulder, and back. Initial labs demonstrated the following: WBC 18.67, AST 274, ALT 426, ALP 517, total bilirubin 11.8. Abdominal ultrasound and MRI demonstrated hepatosplenomegaly, contracted gallbladder, cholelithiasis without ductal dilation, and gallbladder wall thickening. A serological workup demonstrated the patient to be EBV early antigen antibody positive, EBV capsid IgM positive, EBV capsid IgG negative, CMV IgM reactive, CMV quantitative by NAAT not detected, HSV IgM positive, HSV IgG negative. Gastroenterology, obstetrics/gynecology, general surgery, and infectious disease services were consulted during her hospitalization.

Discussion: Hepatic involvement is commonly found with EBV but is typically subclinical. The development of acute hepatitis in this patient may have been multifactorial as she was found to be acutely infected with both HSV and EBV. However, her symptoms suggest EBV as the primary hepatic offender. This case was further complicated by the patient's serology, symptoms, and recent positive pregnancy test. It is possible that recent infections or viral exposures in the setting of pregnancy may have led to a more severe presentation. This case highlights the need to keep EBV on the differential for acute hepatitis and the need to closely monitor pregnant patients. A biopsy was not performed for this patient but microscopic findings of diffuse lymphocytic sinusoidal infiltrate in the “string of beads” pattern can help identify EBV as the cause of hepatic injury when lab findings are unclear.



Disclosures:


Tiffany Wyatt, DO¹, Caleb M. Glover, DO², Maria Kim, BS³, Nicholas Diloreto, DO¹, Gisela Ocasio, DO¹, Dorian Jones, MD¹. P3024 - Acute Hepatitis in a Pregnant 21-Year-Old Female: Unveiling the Impact of Acute EBV, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.