title: [Acute hepatitis due to infectious mononucleosis in a 21-year-old-man].
abstract: A 21-year-old mole was admitted because of fever, fatigue, headache, pharyngitis, abdominal pain, loss of appetite, vomiting and dark urine for three days. The patient denied recent use of medicines or any other drug. His physical examination disclosed jaundice, hepato-splenomegaly, whitish-yellow covered tonsils, bilateral anterior and posterior cervical lymph node enlargement associated with edema on the face and neck. Routine blood tests detected abnormalities in serum bilirubins and liver enzymes (total bilirubin: 14.5 mg/dl, direct-reacting bilirubin: 12.9 mg/dl, AST: 697 U/l, ALT: 619 U/l, alkaline phosphatases: 260 U/l, and GGT: 413 U/l). Serological tests showed negative results for viral hepatitis, cytomegalovirus, HIV-1 and HIV-2, and toxoplasmosis markers, while serology for recent infection by EBV was positive (IgM: 70 and 29 U/ml; EBV IgG: 25 and 156 U/ml). Although infrequently, EBV infection can cause acute hepatitis with accentuated cholestatic jaundice (5% of cases), which may constitute an additional diagnostic challenge for primary care physicians. The patient improved with supportive management and was discharged after 12 days. This case study might contribute to increase the suspicion index about acute hepatitis related to EBV.
authors.affiliation: Catholic University Medical Course, Brasilia, DF, Brazil.
authors.forename: Vitorino
authors.initials: V
authors.lastname: Modesto Dos Santos
authors.affiliation: Catholic University Medical Course, Brasilia, DF, Brazil.
authors.forename: Zilcem
authors.initials: Z
authors.lastname: Da Costa Arruda
authors.affiliation: Catholic University Medical Course, Brasilia, DF, Brazil.
authors.forename: Maira
authors.initials: M
authors.lastname: De Farias Polcheira
authors.affiliation: Catholic University Medical Course, Brasilia, DF, Brazil.
authors.forename: Diogo Wagner
authors.initials: DW
authors.lastname: Da Silva De Souza
authors.affiliation: Catholic University Medical Course, Brasilia, DF, Brazil.
authors.forename: Alessandra Maria
authors.initials: AM
authors.lastname: Rodrigues Oliveira Santos
authors.affiliation: Internal Medicine Department, Armed Forces Hospital, Brasilia, DF, Brazil.
authors.forename: Marcela
authors.initials: M
authors.lastname: Santos Corrêa Da Costa
mesh_terms: D000208:Acute Disease; D000328:Adult; D006525:Hepatitis, Viral, Human / Q000175:diagnosis / Q000209:etiology*; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D007244:Infectious Mononucleosis / Q000150:complications / Q000175:diagnosis*; D008297:Male