title: Severe acute hepatitis and cold agglutinin-related hemolytic anemia secondary to prime infection with Epstein-Barr virus.
abstract: Epstein-Barr virus, a member of the Herpesviridae family, is responsible for the infectious mononucleosis clinical syndrome, which mainly includes the pharyngitis, fever, and lymphadenopathy triad after incubation for 30-50 days. The liver is involved in 80-90% of patients in a self-limiting transient manner, with jaundice being much more uncommon (5%). From a hematological standpoint it may manifest aplastic anemia, neutropenia, and thrombocytopenia. We report a case of infectious mononucleosis that included severe acute hepatitis and was associated with severe hemolytic anemia secondary to cold agglutinins. After exclusion of other etiologies, and given the clinical suspicion of the above association, which was later confirmed by lab tests, empiric therapy was initiated with antiviral agents (aciclovir + valganciclovir) and corticoids, which resulted in a progressive clinical improvement until complete remission. Therefore, we believe that this case report will reinforce the clinical evidence in support of the above combined therapy for serious infectious mononucleosis as a step prior to liver transplantation.
authors.affiliation: Aparato Digestivo, Hospital Universitario Virgen del Rocío, España.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ontanilla Clavijo
authors.affiliation: Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, España.
authors.forename: Julia
authors.initials: J
authors.lastname: Praena Segovia
authors.affiliation: UGC Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, España.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Giráldez Gallego
authors.affiliation: Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, España.
authors.forename: María Elisa
authors.initials: ME
authors.lastname: Cordero Matía
authors.affiliation: UGC Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, España.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Sousa Martín
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis / Q000821:virology*; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007244:Infectious Mononucleosis / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D012720:Severity of Illness Index