title: Characteristics of Epstein-Barr virus hepatitis among patients with jaundice or acute hepatitis.
abstract: BACKGROUND
  Abnormal liver blood tests are common in Epstein-Barr virus (EBV) infection, but symptomatic hepatitis is rare. The demographics, clinical features and outcome of EBV hepatitis are incompletely understood, particularly in the elderly people.
  
  
  OBJECTIVE
  To identify the demographics, presenting features and natural history of EBV hepatitis.
  
  
  METHODS
  Retrospective review of 1995 consecutive patients attending the jaundice hotline clinic over a 13-year period. Data collected included demographic information, presenting features, clinical and laboratory parameters, radiology imaging and clinical outcome.
  
  
  RESULTS
  Seventeen of 1995 (0.85%) had EBV hepatitis. The median age was 40 years (range 18-68 years). Ten of 17 (59%) patients were aged >30 years, and seven of 17 (41%) patients were aged ≥60 years. Fifteen of 17 (88%) patients presented with clinical/biochemical evidence of jaundice. Seventeen of 17 (100%) patients had a serum lymphocytosis at presentation. 2/17 (12%) patients with EBV hepatitis presented with the classical features of infectious mononucleosis (fever, sore throat and lymphadenopathy). Splenomegaly was present in 15/17 (88%) of patients. Symptoms lasted for a median 8 weeks (range 1-12 weeks). Three of 17 (18%) patients required a brief hospital admission.
  
  
  CONCLUSIONS
  In patients presenting with jaundice/hepatitis, EBV hepatitis is an uncommon diagnosis and causes a self-limiting hepatitis. The diagnosis is suggested by the presence of a lymphocytosis and/or splenomegaly. The majority of patients do not have infectious mononucleosis. Compared with infectious mononucleosis, EBV hepatitis affects an older age group, with nearly half of patients being aged more than 60 years. The diagnosis should be considered in all patients with unexplained hepatitis irrespective of their age.
authors.affiliation: Cornwall Gastrointestinal Unit, Royal Cornwall Hospital Truro, UK.
authors.forename: L J
authors.initials: LJ
authors.lastname: Vine
authors.forename: K
authors.initials: K
authors.lastname: Shepherd
authors.forename: J G
authors.initials: JG
authors.lastname: Hunter
authors.forename: R
authors.initials: R
authors.lastname: Madden
authors.forename: C
authors.initials: C
authors.lastname: Thornton
authors.forename: V
authors.initials: V
authors.lastname: Ellis
authors.forename: R P
authors.initials: RP
authors.lastname: Bendall
authors.forename: H R
authors.initials: HR
authors.lastname: Dalton
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000821:virology; D005260:Female; D006525:Hepatitis, Viral, Human / Q000175:diagnosis* / Q000821:virology; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D007244:Infectious Mononucleosis / Q000175:diagnosis; D007565:Jaundice / Q000175:diagnosis* / Q000821:virology; D008111:Liver Function Tests; D008218:Lymphocytosis; D008297:Male; D008875:Middle Aged; D013163:Splenomegaly; D055815:Young Adult