University of California Riverside School of Medicine Redlands, CA
Ashujot Kaur Dang, MD1, Yohannes Haile, BS2, Cameron Furey, MD2, George Saffouri, MD2 1University of California Riverside School of Medicine, Redlands, CA; 2University of California Riverside School of Medicine, Riverside, CA
Introduction: Epstein-Barr virus (EBV) has an estimated 90% global burden and is frequently related to various malignancies (1,2), but symptomatic EBV hepatitis is rare (1%) (3). The epidemiology, clinical features, and outcomes of EBV hepatitis remain poorly understood (3), therefore diagnosis can be challenging. We present a novel case of symptomatic EBV hepatitis in a young patient with a literature review.
Case Description/Methods: A previously healthy 18-year-old female presented with one week of progressively worsening flu-like symptoms. She reported nausea, vomiting, fatigue, myalgias, and diarrhea. Initial evaluation at urgent care led to a prescription of Azithromycin and promethazine. However, her symptoms persisted prompting hospital admission. Initial labs showed elevated aspartate aminotransferase, alanine aminotransferase, INR, and total bilirubin. Despite supportive management, her liver function worsened (Figure 1) with borderline hepatomegaly, normal gallbladder, and patent portal vein on imaging. The patient was empirically started on prednisone (40mg/day) and a detailed autoimmune, hereditary, and infectious workup ordered (Figure 2). By day 3, her labs showed elevated EBV serology and a positive antinuclear antibody with low titer. With her liver function tests improving and symptoms resolving, the clinical picture suggested EBV hepatitis over autoimmune hepatitis, though prednisone was continued pending liver biopsy results. She was ultimately deemed stable for discharge with a follow-up for her biopsy and outpatient gastrointestinal consultation. We conducted a Pubmed search from 2017-2024 to identify similar published articles using the keywords: EBV, Hepatitis, and Symptomatic, and identified 7 similar articles, with 7 patients. We performed a literature review of these cases(Table 1).
Discussion: Patients' ages ranged between 16-62 years (mean 32, 4 female, 3 male). Three out of seven patients who suffered from EBV hepatitis were on immunosuppressive agents or had recent steroid use. The presentation was rather similar with abdominal pain, fever, nausea, and jaundice. 4 out of 7 patients had resolution of symptoms within 2 weeks with supportive management.
There is a paucity of literature that reports cases of symptomatic EBV hepatitis, especially in an immunocompetent adult. This case report contributes to the body of knowledge, emphasizing the importance of larger, multi-center studies to enhance our understanding of the infection and improve preventive measures and outcomes.
Figure: Figure 1: demonstrates the lab trend AST, ALT, Total bilirubin, and ALP trend throughout the hospital stay; notice the uptrending transaminases on day 2.
Figure 2: depicts the extensive workup resulted including infectious, autoimmune, toxic, or metabolic causes to aid the diagnosis, with labs suggestive of EBV hepatitis.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Ashujot Kaur Dang indicated no relevant financial relationships.
Yohannes Haile indicated no relevant financial relationships.
Cameron Furey indicated no relevant financial relationships.
George Saffouri indicated no relevant financial relationships.
Ashujot Kaur Dang, MD1, Yohannes Haile, BS2, Cameron Furey, MD2, George Saffouri, MD2. P1301 - Behind the Barr: A Case of Acute EBV Hepatitis and Literature Review, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
