Epstein-Barr Virus (EBV) can result in a hepatitis which is often subclinical and self-limited. However, more serious infections can occur, especially if the patient is immunocompromised. The diagnosis hinges on the interpretation of clinical, histologic and laboratory findings.
Clinical features:
(1) fever
(2) variable hepatomegaly
(3) rare fulminant hepatitis
(4) rare chronic active infection
(5) rare jaundice
Laboratory findings:
(1) elevated serum transaminases
(2) variable elevation of serum total bilirubin
(3) anti-VCA IgM in primary infection
(4) positive EBV viral load by PCR
Liver biopsy shows:
(1) lymphocytic portal triaditis
(2) intact lobular architecture
(3) sinusoidal infiltration by atypical T cells
In situ hybridization of EBV-encoded RNA (EBER) can help establish the diagnosis.
Differential diagnosis:
(1) drug-induced hepatitis (phenytoin, dapsone, para-aminosalicylate, other)
(2) autoimmune hepatitis
(3) transplant rejection
(4) hepatosplenic T-cell lymphoma
(5) hepatic posttransplant lymphoproliferative disorder
(6) other forms of viral hepatitis
