SHM Converge Scientific Abstract ePoster Gallery-Beyond the Monospot: A Case of Ebv Hepatitis and Autoimmune Hemolysis Unveiling a Diagnostic Pitfall

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This case highlights a diagnostic pitfall in Epstein-Barr virus (EBV) infection. A previously healthy 24-year-old woman presented with five days of right upper quadrant pain, nausea, vomiting, and diarrhea, along with marked hepatocellular transaminitis and leukopenia. Her initial Monospot and viral hepatitis panel were negative, which could have falsely lowered suspicion for EBV. Over the next two hospital days, her liver enzymes worsened into the 700s, and she developed worsening cytopenias with laboratory evidence of hemolysis, including elevated LDH and low haptoglobin. <br /><br />Because EBV remained clinically suspected, EBV-specific serologies were obtained and showed positive viral capsid antigen (VCA) IgM and IgG, confirming acute EBV infection. A direct antiglobulin test was also positive for IgG, confirming autoimmune hemolytic anemia (AIHA), a rare EBV complication. The patient’s blood counts improved over the course of hospitalization with supportive care.<br /><br />The discussion emphasizes that EBV can present atypically, including with hepatitis and hematologic abnormalities, even without classic findings such as pharyngitis or lymphadenopathy. Hepatitis is common in EBV but usually mild, whereas AIHA is uncommon, occurring in less than 1% of cases. The Monospot test is unreliable early in infection, with substantial false-negative rates, so a negative result should not exclude EBV when clinical suspicion remains high. EBV-specific serologies—especially VCA IgM and EBNA IgG—are more useful for confirming acute infection and distinguishing it from prior exposure. <br /><br />The key clinical takeaway is to continue evaluating for EBV in patients with transaminitis and cytopenias despite a negative Monospot, and to use EBV-specific serologic testing to avoid missed or delayed diagnosis.

Asset Subtitle

Mary Xoxe

Meta Tag

Author List Emily Wang, Mary Xoxe, Sammar Rasheed, Tirth Patel

Category Clinical Vignettes

Concept Epstein-Barr Virus

Concept Syphilis Serology

Concept Acute Hepatitis

Concept Heterophile Antibody Test

Concept Viral Capsid Antigen IgM

Distinguished Non-Finalist

Presenter Organization Cooper Medical School of Rowan University

Presenting Author Mary Xoxe

Track Adult

Keywords

Epstein-Barr virus

EBV infection

Monospot false negative

acute hepatitis

transaminitis

cytopenias

autoimmune hemolytic anemia

VCA IgM

VCA IgG

EBV serology

Epstein-Barr Virus

Syphilis Serology

Acute Hepatitis

Heterophile Antibody Test

Viral Capsid Antigen IgM