Acute pancreatitis as atypical manifestation of Epstein-Barr virus infection.

A 15-year-old male, no relevant medical history, was admitted after a 5 day episode of epigastric pain together with referred pain in the back. Denial of toxic habits. Having received antibiotic treatment for tonsillitis days before his admission. A physical examination revealed the presence of a right occipital adenopathy and bilateral inguinal lymphadenopathy, as well as erythematous pharynx and abdominal pain on mesogastric palpation without peritoneal irritation. Analytical data highlighted a lymphomonocytosis with 7,710 leukocytes/mm (43.7 % lymphocytes, 13.9 % monocytes); erythrocyte sedimentation rate, 43 mm/h; CRP, 16.4 mg/dL, and amylase, 1,251 IU/L (range 28-100 IU/L). Requested serology was positive for the presence of heterophile antibodies to Epstein-Barr virus (EBV). The peripheral blood smear detected lymphomonocytosis, with a predominance of activated mature cells suggesting a viral infection. An abdominal ultrasound eliminated the possibility of pancreatitis caused by gallstones. Abdominal CT scan showed a globular pancreas, mild hepatosplenomegaly, moderate ascites and significant left paraaortic lymphadenopathy, all of which suggested a probable viral process (type EBV infection).