Acute cholestatic hepatitis induced by Epstein–Barr virus infection in an adult: a case report

BACKGROUND Acute cholestatic hepatitis without features of infectious mononucleosis is a rare presentation of primary Epstein-Barr infection, with only several cases previously reported in the medical literature. Early investigation for Epstein-Barr virus in febrile patients with deranged liver function tests and no demonstrable biliary obstruction on imaging can expedite both diagnosis and treatment, thereby avoiding costly or invasive procedures such as liver biopsy. CASE PRESENTATION A 59-year-old white woman of Anglo-Saxon descent presenting with a febrile illness was noted to have a cholestatic picture of deranged liver function tests. Over the following week a progressive obstructive jaundice developed, with no evidence of choledocholithiasis on ultrasound or magnetic resonance cholangiopancreatography. Specific immunoglobulin M antibodies against Epstein-Barr virus were detected in her serum and the diagnosis of Epstein-Barr hepatitis was confirmed by polymerase chain reaction testing. Supportive treatment was implemented and her liver function had normalized 3 months after presentation. CONCLUSIONS Epstein-Barr virus is associated with a wide variety of clinical manifestations and can present as cholestatic hepatitis with or without features of infectious mononucleosis. While the diagnosis is often suggested by serological testing, Epstein-Barr virus polymerase chain reaction is a new non-invasive laboratory study that can help identify infection in cases where the clinical presentation is atypical.