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False-positive serologies for acute hepatitis A and autoimmune hepatitis in a patient with acute Epstein–Barr virus infection
  1. Marika Valota1,
  2. Friedrich Thienemann1,2 and
  3. Benjamin Misselwitz3
  1. 1 Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
  2. 2 Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
  3. 3 Department of Gastroenterology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Dr Friedrich Thienemann, friedrich.thienemann{at}


Acute hepatitis remains a diagnostic challenge, and numerous infectious, metabolic and autoimmune diseases need to be effectively excluded. We present a case of a young woman with malaise, fever, jaundice and deranged liver function tests. Testing for Epstein–Barr virus (EBV) virus capsid antigen IgM/IgG was positive. Total IgG was elevated, along with positive serology for anti-hepatitis A virus (HAV)-IgM, antinuclear antibodies (ANAs) and soluble liver antigen (SLA) leading to the differential diagnosis of acute hepatitis A and autoimmune hepatitis. No specific treatment was started and liver function gradually improved. At week 4, HAV IgG and IgM were negative. At month 4, ANA and SLA were negative and total IgG normalised; EBV nuclear antigen became positive. Testing for EBV is an investigation required at baseline in acute hepatitis and physicians should carefully evaluate serological results, including those for viral and autoimmune hepatitis that may be falsely positive in infectious mononucleosis.

  • hepatitis other
  • hepatitis and other GI infections
  • immunology
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  • Contributors All authors contributed to patient care, concept and design of the manuscript. MV wrote the first draft, and FT and BM revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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