title: Prolonged hepatitis and jaundice: a rare complication of paediatric Epstein-Barr virus infection.
abstract: We herein report the case of a 14-year-old girl with Epstein-Barr virus (EBV) infectious mononucleosis who developed prolonged hepatitis and jaundice. At presentation, she had tender hepatomegaly with a markedly deranged liver function test. Abdominal ultrasonography showed hepatomegaly and a thickened gallbladder wall. During the subsequent 11 weeks, her transaminases showed two further peaks, which corresponded with clinical deterioration. Her highest alanine transaminase level was 1,795 µ/L and total bilirubin level was 154 µmol/L. She recovered fully with conservative management. EBV-related liver involvement is typically mild and self-limiting. We believe that tender hepatomegaly and gallbladder thickening may be important predictors of significant liver involvement. Although multiple transaminase peaks may occur, we do not consider this an indication for antiviral or immunosuppressive therapy. In the absence of strong evidence supporting the use of any specific therapy, we recommend a conservative approach for an immunocompetent patient.
authors.affiliation: Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Zhen Han
authors.initials: ZH
authors.lastname: Tan
authors.affiliation: Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Kong Boo
authors.initials: KB
authors.lastname: Phua
authors.affiliation: Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Christina
authors.initials: C
authors.lastname: Ong
authors.affiliation: Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Ajmal
authors.initials: A
authors.lastname: Kader
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D002681:China; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D005704:Gallbladder / Q000473:pathology; D006505:Hepatitis / Q000150:complications*; D006529:Hepatomegaly / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007565:Jaundice / Q000150:complications*; D008099:Liver / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D014463:Ultrasonography; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase; D001663:Bilirubin
keywords: Epstein-Barr virus; hepatitis; jaundice; mononucleosis; paediatric