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

Lejla Čalkić; Lejla Bajramović-Omeragić; Adnan Mujezinović

doi:10.17392/1031-19

Review paper

Received: 12.04.2019. >> Accepted: 16.05.2019. >> Published: 10.05.2019. Biochemistry

<< Prev | Next >>

PDF

https://doi.org/10.17392/1031-19

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

Abstract

Aim
To describe a case of an eight-year-old boy with chronic Epstein-Barr virus (EBV) hepatitis with incipient cirrhosis, rarely found in practice.
Methods
The diagnosis was based on findings of specific IgG serum antibodies and EBV positive liver biopsy. Other etiologies of hepatitis 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 hepatitis without icterus was found in the boy first time at the age of three. He got sick again in april 2018 with fever, minor loss of appetite and weakness, skin and sclera were anicteric, no enlarged neck lymph nodes. Ultrasonography of the spleen revealed a spleen diameter of 10.7 cm, while the liver was 11.8 cm. Laboratory findings, sedimentation, blood count, C reactive protein (CRP) were all normal. Ten days and a month later an increase of aminotransferase was noticed. The liver biopsy and PCR EBV DNA were performed six months of disease onset. The disease had lasted for about one more year with loss of strength and an increase of aminotransferase with maximum value of 3-4 times higher than normal one. The therapy was supportive.
Conclusion
Chronic EBV hepatitis is very rare. In differential diagnosis of hepatitis and unclear febrile conditions, EBV infection should not be forgotten.

Keywords:

biopsy,

differential diagnosis,

liver cirrhosis

References

Petrova M, Kamburov V. Epstein-Barr virus: silent companion or causative agent of chronic liver disease? World J Gastroenterol 2010:4130–4.

Lee T, Ko Y. Chronic active EBV infection: the experience of the Samsung Medical Center in South Korea. Bol Med Hosp Infant Mex 2016:10–7.

Drebber U, Kasper H, Krupacz J, Haferkamp K, Kern M, Steffen H, et al. The role of Epstein-Barr virus in acute and chronic hepatitis. J Hepatol 2006:879–85.

Petrova M, Muhtarova M, Nikolova M, Magaev S, Taskov H, Nikolovska D, et al. Chronic Epstein-Barr virus-related hepatitis in immunocompetent patients. World J Gastroenterol 2006:5711–6.

De Paschale M, Clerici P. Serological diagnosis of Epstein-Barr virus infection: problems and solutions. World J Virol 2012:31–43.

Sakamoto Y, Mariya Y, Kubo K. Quantification of Epstein-Barr virus DNA is helpful for evaluation of chronic active Epstein-Barr virus infection. Tohoku J Exp Med 2012:307–11.

Kimura H, Cohen J. Chronic Active Epstein-Barr virus disease. Front Immunol 2017:1867.

Straus S. The chronic mononucleosis syndrome. J Infect Dis 1988:405–12.

Brkić S, Jovanović J, Preveden T. Hronična infektivna mononukleoza. Med Pregl 2003;(8):362–72.

Hatton O, Harris-Arnold A, Schaffert S, Krams S, Martinez O. The interplay between Epstein-Barr virus and B-lymphocytes: implications for infection, immunity, and disease. Immunol Res 2014:268–76.

Čanović P, Gajović O, Todorović Z, Mijailović Ž. Epstein-Barr virusni hepatitis sa pojavom ikterusaprikaz slučaja. Med Preg 2006;(4):178–82.

Vuković V, Mijailović Z, Borovčanin N. Epstein-Barr virusni hepatitis sa pojavom ikterusa -prikaz slučaja. Med Čas (Kragujevac) 2010:14–8.

Čanović P, Vranić A, Petrović S, Raković I, Jovičić P, Hamzagic B, et al. Analylis of clinical, haematological and biochemical parameters in patient with infectious mononucleosis. Ser J Exp Clin Res 2015:291–5.

Moniri A, Tabarsi P, Marjani M, Doosti Z. Acute Epstein-Barr virus hepatitis without mononucleosis syndrome: a case report. Gastroenterol Hepatol Bed Bench 2017:147–9.

Taylor G, Long H, Brooks J, Rickinson A, Hislop A. The immunology of Epstein-Barr virusinduced disease. Annu Rev Immunol 2015:787–821.

Sitki-Green D, Covington M, Raab-Traub N. Compartmentalization and transmission of multiple Epstein-Barr virus strains in asymptomatic carriers. J Virol 2003:1840–7.

Hsu J, Glaser S. Epstein-Barr virus-associated malignancies: epidemiologic patterns and etiologic implications. Crit Rev Oncol Hematol 2000:27–53.