An overlooked cause of hepatitis and thrombocytopenia with clinico-biochemical discrepancy: A case of infectious mononucleosis

Year 2023, , 139 - 142, 29.10.2023

Ecem Demirkan Alper Tuna Güven

https://doi.org/10.56016/dahudermj.1367825

Abstract

A 22-year-old male was admitted to the outpatient clinic with fatigue, fever, and a sore throat. High transaminase levels, moderate thrombocytopenia, and elevated acute phase reactants were detected ten times. Ultrasound imaging revealed hepatosplenomegaly and a peripheral blood smear showed Downey cells. Epstein-Barr virus (EBV) infection was considered the definite diagnosis, and EBV serology was performed. His mild clinic improved to normal within days, but the patient's clinical progression and laboratory findings were incompatible. Laboratory results were on the extreme side, while the clinic was mildly deteriorating. EBV viral capsid antigen IgM was high, supporting the initial diagnosis. Biochemical normalization followed clinical improvement many days later. Clinicians should know that EBV infection may be mild, while laboratory results illustrate extreme findings.

Keywords

Epstein Barr virus, aminotransferase, thrombocytopenia, hepatomegaly, splenomegaly

References

• Çeltik C. , Küçükuğurluoğlu Y. , Balcı D. B. , Duran R. , Karasalihoğlu S. , Öner N. Evaluation of Clinical and Laboratory Features of Epstein-Barr Virus-Associated Acute Infectious Mononucleosis in Children. Balkan Medical Journal. 2008; 2008(3): -
• Womack J, Jimenez M. Common questions about infectious mononucleosis. Am Fam Physician. 2015;91(6):372-376.
• Kofteridis DP, Koulentaki M, Valachis A, et al. Epstein Barr virus hepatitis. Eur J Intern Med. 2011;22(1):73-76. doi:10.1016/j.ejim.2010.07.016
• Cohen JI. Epstein-Barr virus infection. N Engl J Med. 2000;343(7):481-492. doi:10.1056/NEJM200008173430707
• Rea TD, Russo JE, Katon W, Ashley RL, Buchwald DS. Prospective study of the natural history of infectious mononucleosis caused by Epstein-Barr virus. J Am Board Fam Pract. 2001;14(4):234-242.
• Méndez-Sánchez N, Aguilar-Domínguez C, Chávez-Tapia NC, Uribe M. Hepatic manifestations of Epstein-Barr viral infection. Ann Hepatol. 2005;4(3):205-209.
• van de Veerdonk FL, Wever PC, Hermans MH, et al. IL-18 serum concentration is markedly elevated in acute EBV infection and can serve as a marker for disease severity. J Infect Dis. 2012;206(2):197-201. doi:10.1093/infdis/jis335
• Theodory B, Dopp M, Swisher AR, Flores RM, Robb PM. Epstein-Barr virus induced acute hepatitis with hyperferritinemia: A rare presentation. IDCases. 2023;33:e01872. Published 2023 Aug 9. doi:10.1016/j.idcr.2023.e01872
• Kiiskinen SJ, Luomala O, Häkkinen T, Lukinmaa-Åberg S, Siitonen A. Evaluation of the Serological Point-of-Care Testing of Infectious Mononucleosis by Data of External Quality Control Samples. Microbiol Insights. 2020;13:1178636120977481. Published 2020 Dec 3. doi:10.1177/1178636120977481
• Ceraulo AS, Bytomski JR. Infectious Mononucleosis Management in Athletes. Clin Sports Med. 2019;38(4):555-561. doi:10.1016/j.csm.2019.06.002