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CASE REPORT
Epstein-Barr virus-associated cholestatic hepatitis
  1. Inês Salva1,
  2. Inês Vaz Silva2,
  3. Florbela Cunha2
  1. 1Department of Pediatrics, Hospital de Dona Estefânia, Lisbon, Portugal
  2. 2Department of Pediatrics, Hospital Vila Franca de Xira, Lisbon, Portugal
  1. Correspondence to Dr Inês Salva, ines.salva{at}gmail.com

Summary

Epstein-Barr virus infection is common in children, usually presenting as infectious mononucleosis, including fever, tonsillitis and lymphadenopathy associated with self-resolving increase in transaminases. Cholestasis is rare in children with only a few cases reported but it was described in up to 55% of the adult population affected. We present a case of a 6-year-old boy with fever, vomiting and choluria. The physical examination showed hepatomegaly and jaundice and was otherwise unremarkable. The laboratory studies revealed increased transaminases (aspartate aminotransferase 97 U/L, alanine aminotransferase 166 U/L), hyperbilirubinaemia (total bilirubin 3.2 mg/dL, direct bilirubin 2.89 mg/dL) and increased γ-glutamyl transpeptidase (114 mg/dL). Urine urobilinogen was increased. The abdominal ultrasound showed hepatomegaly. Epstein-Barr viral capsid antibody IgM was positive and IgG was negative. Serological studies for other viruses were negative. We underline the need to consider Epstein-Barr virus in the cholestatic hepatitis differential diagnosis, in order to avoid unnecessary investigations.

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