Infectious mononucleosis (Epstein-Barr virus infection) and chronic hepatitis

摘要

Aim To describe a case of an eight-year-old boy with chronic Epstein-Barr virus (EBV) hepatitis with incipient cirrhosis, rarelyfound in practice.Methods The diagnosis was based on findings of specific IgG serumantibodies and EBV positive liver biopsy. Other etiologies ofhepatitis were excluded: autoimmune hepatitis, viral hepatitis A,B, or C, cytomegalovirus (CMV), herpes simplex virus (HSV),adenovirus infection, toxoplasma infection.Results A mild form of infectious mononucleosis with acute hepatitiswithout icterus was found in the boy first time at the ageof three. He got sick again in april 2018 with fever, minor loss ofappetite and weakness, skin and sclera were anicteric, no enlargedneck lymph nodes. Ultrasonography of the spleen revealed a spleendiameter of 10.7 cm, while the liver was 11.8 cm. Laboratoryfindings, sedimentation, blood count, C reactive protein (CRP)were all normal. Ten days and a month later an increase of aminotransferasewas noticed. The liver biopsy and PCR EBV DNAwere performed six months of disease onset. The disease had lastedfor about one more year with loss of strength and an increaseof aminotransferase with maximum value of 3-4 times higher thannormal one. The therapy was supportive.Conclusion Chronic EBV hepatitis is very rare. In differential diagnosisof hepatitis and unclear febrile conditions, EBV infectionshould not be forgotten.