Chronic Epstein-Barr virus infection: a cause of granulomatous hepatitis?
A 37-year-old man had fever, weight loss, malaise, right upper quadrant pain, lymphadenopathy, and a twofold elevation of serum alkaline phosphatase, transaminases, and gamma glutamyl transpeptidase. Granulomas were found on liver biopsy after 2 1/2 months of illness. Treatment with isoniazid and rifampin for 2 months did not lead to improvement in fever or symptoms, but prednisone caused a prompt resolution. Positive IgM antibodies to the viral capsule antigen followed by marked elevation of the IgG fraction suggest chronic Epstein-Barr virus infection to be the etiology. The patient was asymptomatic without treatment 14 months after onset of the illness.
Biest
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University of Missouri Kansas City School of Medicine, Gastroenterology Section, Truman Medical Center.
Schubert
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D000328:Adult; D002908:Chronic Disease; D005335:Fever of Unknown Origin / Q000209:etiology; D006099:Granuloma / Q000209:etiology*; D006505:Hepatitis / Q000209:etiology*; D006566:Herpesviridae Infections / Q000150:complications*; D004854:Herpesvirus 4, Human; D006801:Humans; D008107:Liver Diseases / Q000209:etiology; D008297:Male