SHM Converge Scientific Abstract ePoster Gallery-Kissing Disease Hepatitis

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This case describes a young woman with 4 weeks of abdominal pain followed by fever, chills, nausea, vomiting, jaundice, cervical lymphadenopathy, and a diffuse pruritic macular rash involving the trunk, extremities, and palms. Initial evaluation showed marked hepatitis with AST 994 U/L, ALT 1,974 U/L, total bilirubin 4.5 mg/dL, direct bilirubin 3.1 mg/dL, and mildly elevated alkaline phosphatase. Because she lived in a wooded area and had systemic symptoms, clinicians considered autoimmune hepatitis, drug-induced liver injury, and tick-borne illness. These were ruled out by negative autoimmune markers, negative hepatitis A/B/C/E, HIV, CMV, Lyme, Rocky Mountain spotted fever, and Ehrlichia testing.<br /><br />Epstein-Barr virus testing was positive for both IgM and IgG, with detectable viral load, supporting a diagnosis of acute EBV hepatitis. Imaging showed only mild splenomegaly and no other significant abnormalities. The patient received supportive care; prophylactic doxycycline was started briefly but stopped once tick-borne infection was excluded. Her fever, nausea, and vomiting had already improved just before admission. Jaundice resolved on hospital day 1, and rash and abdominal pain resolved by hospital day 4. Liver enzymes peaked early and then steadily normalized at follow-up.<br /><br />The report emphasizes that EBV infection is common, but acute hepatitis with severe transaminase elevation is unusual. While mild AST/ALT elevation is typical in infectious mononucleosis, jaundice and rash occur in a minority of cases, and very high transaminases are rare. Clinicians should therefore consider EBV hepatitis in patients with mononucleosis-like illness plus rash, jaundice, and significant liver injury, even when the presentation is atypical.

Asset Subtitle

Brendan Lawson

Meta Tag

Author List Brendan Lawson, Davis Phillips, Evan Raff, Indraneel Prabhu, Taylor Holmes

Category Clinical Vignettes

Concept Epstein-Barr Virus

Concept Acute Hepatitis

Concept Epstein-Barr virus infectious mononucleosis

Concept Supportive Care

Concept Laboratory Findings

Distinguished Non-Finalist

Presenter Organization University of North Carolina Chapel Hill School of Medicine

Presenting Author Brendan Lawson

Track Adult

Keywords

Epstein-Barr virus

acute EBV hepatitis

jaundice

macular rash

abdominal pain

hepatitis

transaminase elevation

splenomegaly

infectious mononucleosis

supportive care

Epstein-Barr Virus

Acute Hepatitis

Epstein-Barr virus infectious mononucleosis

Supportive Care

Laboratory Findings