Acute hepatitis due to EBV

We discussed a case of a healthy young man who presented with fevers, malaise, n/v, found to have posterior cervical lymphadenopathy and acute hepatitis due to infectious mononucleosis.

Clinical manifestations

  • Fevers, pharyngitis, tonsillar exudates, malaise, lymphadenopathy (posterior cervical / posterior auricular), atypical lymphocytosis
  • Splenomegaly
  • Hepatitis

Diagnosis

  • Heterophile / Monospot test (low sensitivity and specificity). Can have false negative during early infection
  • EBV specific antibodies to viral capsid Ag (earlier increase in serum levels) or nuclear Ag (later increase in serum levels)

Complications

  • Acute complications
    • Rash (classically associated with administrations of ampicillin)
    • Peritonsillar abscess (watch out for airway obstruction!)
  • Lymphoproliferative disorders (e.g. HLH, lymphomatoid granulomatosis)
  • Malignancies (e.g. lymphomas, nasopharyngeal carcinoma)

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