title: A Complicated Course of Acute Viral Induced Pharyngitis, Icteric Hepatitis, Acalculous Cholecystitis, and Skin Rash.
abstract: This case reveals the complexities and challenges in the diagnosis of acute Epstein-Barr virus (EBV) infection, indicating the potential relationship between EBV infection and severe icteric hepatitis, acalculous cholecystitis, and lymphocytic vasculitis. We suggest including EBV infectious mononucleosis in the list of differential diagnoses when any of these clinical syndromes (or a combination thereof) occurs without apparent cause, especially in the presence of lymphocytosis. To our knowledge, this is the first report to suggest the possible role of EBV in the pathogenesis of cutaneous lymphocytic vasculitis. Also it is possible that EBV infection triggered the flare-up of the underlying rheumatologic disease. Therefore, it could be assumed that a part of the clinical syndrome (e.g., dermatologic manifestations) might be related to the flare-up of the underlying rheumatologic disease.
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Fereshte
authors.identifier: 0000-0002-0766-4286
authors.initials: F
authors.lastname: Sheybani
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: HamidReza
authors.identifier: 0000-0002-3230-5576
authors.initials: H
authors.lastname: Naderi
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Seddigheh Sadat
authors.initials: SS
authors.lastname: Erfani
authors.affiliation: Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Masoumeh
authors.identifier: 0000-0003-2501-2684
authors.initials: M
authors.lastname: Gharib