Mixed Hemolytic Anemia and Cholestatic Hepatitis Associated with Epstein-Barr Virus Infection
DOI:
https://doi.org/10.24950/rspmi.2660Keywords:
Anemia, Hemolytic, Autoimmune, Cholestasis, Epstein-Barr Virus Infections, HepatitisAbstract
Epstein-Barr virus (EBV) infection is quite common and is mostly asymptomatic. However, although rare, complications can be potentially severe.
This is the case of a previously healthy 19-year-old female patient admitted to the emergency department with fever, jaundice, dark urine, abdominal pain, and periorbital edema. On examination, she was febrile, jaundiced, with hepatomegaly and tenderness in the right upper quadrant and epigastric region. Laboratory tests revealed mixed hemolytic anemia, with a direct antiglobulin test positive for IgG, IgM, and C3d, and a positive cold agglutinin test. A mixed-pattern hepatitis was also identified, along with hyperferritinemia and elevated transaminases. Abdominal ultrasound showed hepatosplenomegaly. EBV serology and viral load were positive. Treatment with prednisolone at 1 mg/kg was initiated, with progressive clinical and laboratory improvement.
Our case describes two rare presentations of EBV and highlights the importance of an accurate diagnosis for the early initiation of specific therapy.
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