title: Cholestatic Hepatitis Induced by Epstein-Barr Virus in a Pediatric Population.
abstract: OBJECTIVE
  We present 5 cases of Epstein-Barr virus (EBV)-induced cholestatic hepatitis (CH) and review all additional pediatric cases from the literature.
  
  
  METHODS
  The medical records of 5 patients with EBV-induced CH were reviewed. A comprehensive review of the literature was performed.
  
  
  RESULTS
  Including our patients, a total of 17 patients with EBV-induced CH were reviewed. The average age was 11 years (range 1-18 years); male to female ratio was 0.9:1. The most common presenting symptoms included fever, jaundice, and cervical lymphadenopathy. However, a significant number of patients presented with jaundice alone, without other suggestive signs of an EBV infection. Hepatocellular enzyme levels were significantly higher than in classical infectious mononucleosis. In many cases, serum alkaline phosphatase was also elevated, accompanied by direct hyperbilirubinemia.
  
  
  CONCLUSIONS
  EBV infection should be included in the differential diagnosis of CH in all age groups. In the vast majority, full recovery is expected.
authors: Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Vered
authors: V
authors: Shkalim-Zemer
authors: Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel kerens411@gmail.com.
authors: Keren
authors: K
authors: Shahar-Nissan
authors: Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Liat
authors: L
authors: Ashkenazi-Hoffnung
authors: Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Jacob
authors: J
authors: Amir
authors: Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Efraim
authors: E
authors: Bilavsky
mesh_terms: D000293:Adolescent; D000469:Alkaline Phosphatase / Q000097:blood; D002675:Child, Preschool; D002779:Cholestasis / Q000209:etiology*; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D006505:Hepatitis / Q000209:etiology*; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications; D008297:Male
chemical_list: D000469:Alkaline Phosphatase
keywords: Epstein-Barr virus; cholestatic hepatitis; infectious mononucleosis; jaundice