An unusual presentation of Epstein-Barr Virus induced hepatitis in a 15-month-old child

Resumen

Objective: We report an atypical case of hepatitis in an infant that could be helpful to physicians of various specialties, as it demonstrates an atypical clinical and laboratorial manifestation of a disease not so common at that age and that could have gone undiagnosed. Case Description: A 15-month-old female, immunocompetent patient was referred to the hospital with a 3-day history of fever, vomiting, and diarrhea. The patient presented with alternation between sleepiness and irritation associated with rapid increase in serum liver enzymes levels, but no jaundice. Neurologic evaluation showed no meningeal signs and no encephalic morphological abnormalities were observed in a cranial CT scan. Treatment consisted of symptomatic medication and daily evaluation for signs of hepatic encephalopa- thy or bleeding. A serological panel showed negative IgM but positive IgG reactivity against Cytomega- lovirus (CMV) and IgM and IgG negative immunoreactivity against HAV. She was not tested for Hepatits B (HBV) or Hepatits C (HCV). Positive immunoreactivity against the Epstein-Barr virus capsid antigen (EBV VCA) IgM and negative reactivity against IgG, indicated a diagnosis of EBV-induced acute hepatitis. The patient was discharged asymptomatic after 11 days, with decreasing serum liver enzymes levels. A 15-day follow up evidenced complete remission of symptoms and normalized laboratory tests. Comments: Hepatic involvement in infections by Epstein-Barr Virus is common, presenting with moderate and transient increase in liver enzymes. It can go undetected and resolve spontaneously, while clinical manifestations of hepatitis are infrequent. In this report, we present an unusual case of a pediatric patient with hepatitis induced by EBV infection, along with a review of the literature. According to our search, no other EBV-induced hepatitis case reports have been published involving an immunocompetent patient under 2 years of age