title: Epstein-Barr virus-associated cholestatic hepatitis.
abstract: Epstein-Barr virus infection is common in children, usually presenting as infectious mononucleosis, including fever, tonsillitis and lymphadenopathy associated with self-resolving increase in transaminases. Cholestasis is rare in children with only a few cases reported but it was described in up to 55% of the adult population affected. We present a case of a 6-year-old boy with fever, vomiting and choluria. The physical examination showed hepatomegaly and jaundice and was otherwise unremarkable. The laboratory studies revealed increased transaminases (aspartate aminotransferase 97 U/L, alanine aminotransferase 166 U/L), hyperbilirubinaemia (total bilirubin 3.2 mg/dL, direct bilirubin 2.89 mg/dL) and increased γ-glutamyl transpeptidase (114 mg/dL). Urine urobilinogen was increased. The abdominal ultrasound showed hepatomegaly. Epstein-Barr viral capsid antibody IgM was positive and IgG was negative. Serological studies for other viruses were negative. We underline the need to consider Epstein-Barr virus in the cholestatic hepatitis differential diagnosis, in order to avoid unnecessary investigations.
authors.affiliation: Department of Pediatrics, Hospital de Dona Estefânia, Lisbon, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Salva
authors.forename: Inês Vaz
authors.initials: IV
authors.lastname: Silva
authors.forename: Florbela
authors.initials: F
authors.lastname: Cunha
mesh_terms: D001663:Bilirubin / Q000097:blood; D002213:Capsid / Q000276:immunology; D002648:Child; D002779:Cholestasis / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000175:diagnosis / Q000378:metabolism / Q000821:virology*; D006529:Hepatomegaly / Q000175:diagnosis / Q000209:etiology / Q000821:virology; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D006932:Hyperbilirubinemia / Q000175:diagnosis / Q000209:etiology / Q000821:virology; D007074:Immunoglobulin G / Q000378:metabolism; D007075:Immunoglobulin M / Q000378:metabolism; D007565:Jaundice / Q000175:diagnosis / Q000209:etiology / Q000821:virology; D008099:Liver / Q000201:enzymology / Q000473:pathology* / Q000821:virology; D008111:Liver Function Tests; D008297:Male; D000637:Transaminases / Q000097:blood*; D014558:Urobilinogen / Q000652:urine; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M; D014558:Urobilinogen; D005723:gamma-Glutamyltransferase; D000637:Transaminases; D001663:Bilirubin