University of Oklahoma Health Sciences Center Oklahoma City, OK, United States
Satyam Krishan, MD, Andrea T. Fernandez, MD, Bryce Yohannan, MD, Arsalan Khan, MD, Blake Jacobs, MD University of Oklahoma Health Sciences Center, Oklahoma City, OK
Introduction: Infectious Mononucleosis (IM) caused by Epstein-Barr Virus (EBV) has been demonstrated in all population groups with a peak incidence found in the 15 to 24-year age group. The most common manifestations of IM include pharyngitis, fever, malaise, and lymphadenopathy. We present a case of a young adult who presented with jaundice as a prominent symptom of EBV.
Case Description/Methods: An 18-year-old female presented to the emergency room with generalized rash, jaundice and nausea. Labs were notable for WBC 12.27 K/mm3, total bilirubin 8.2 mg/dL, direct bilirubin 5.6 mg/dL, AST 270 Units/L, ALT 288 Units/L, total alkaline phosphatase 264 Units/L. MR abdomen showed nonspecific gallbladder wall thickening and enlarged spleen measuring 16 cm. On further investigation, it was found that prior to coming to the ER she had visited her primary care physician due to several days of pharyngitis with associated hoarseness and dysphagia. She was being treated with amoxicillin as an outpatient for streptococcus pharyngitis. Given recent antibiotic use and clinical presentation, the initial differential for acute cholestatic hepatitis included acute cholecystitis vs. drug induced liver injury vs. EBV. Rapid strep test and monospot test were positive for streptococcal pharyngitis and EBV, respectively. Her clinical picture was most consistent with EBV induced cholestasis. Amoxicillin was discontinued and her streptococcal pharyngitis was treated with appropriate alternate antibiotics. IM was treated conservatively with resolution of transaminitis and jaundice on follow up.
Discussion: Literature review shows EBV has varied presentations and has been associated with acute cholestatic hepatitis as described above. However, presentation with jaundice remains a rare phenomenon. Our patient presented with jaundice and nonspecific abdominal symptoms which led us to pursue additional testing with imaging to rule out etiologies such as acute cholecystitis or choledocholithiasis which would require urgent intervention. Her rash was associated with amoxicillin use in the setting of EBV which resolved after stopping the causative agent. EBV induced cholestatic hepatitis remains an important consideration when evaluating transaminitis in the appropriate clinical setting to minimize unnecessary imaging and consultation in cases of equivocal imaging.
Satyam Krishan indicated no relevant financial relationships.
Andrea Fernandez indicated no relevant financial relationships.
Bryce Yohannan indicated no relevant financial relationships.
Arsalan Khan indicated no relevant financial relationships.
Blake Jacobs indicated no relevant financial relationships.
Satyam Krishan, MD, Andrea T. Fernandez, MD, Bryce Yohannan, MD, Arsalan Khan, MD, Blake Jacobs, MD. P2883 - Jaundice: A Presenting Sign of Epstein-Barr Virus in a Young Adult, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.