SHM Converge Scientific Abstract ePoster Gallery-Rare Case of Infectious Mononucleosis (Im) Presenting as Jaundice

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This case report describes a rare presentation of infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV) in an 18-year-old woman who presented with two days of jaundice and dark urine, but without the usual IM symptoms such as fever, sore throat, or flu-like illness. On exam, she had conjunctival icterus and axillary lymphadenopathy.<br /><br />Her laboratory results showed mixed hepatobiliary abnormalities, including elevated AST, ALT, alkaline phosphatase, gamma-glutamyl transferase, and bilirubin. A hepatitis panel was negative, and imaging ruled out biliary obstruction. Although oral contraceptives were stopped, her liver tests continued to worsen. Additional testing showed elevated LDH, low haptoglobin, and a positive direct antiglobulin test, confirming hemolytic anemia. Peripheral smear findings included red blood cell agglutination and reactive lymphocytes. EBV IgM antibody testing was positive, establishing the diagnosis.<br /><br />The discussion emphasizes that EBV commonly affects adolescents and young adults and usually causes classic IM symptoms with lymphocytosis, but liver involvement is generally mild and self-limited. Cholestatic jaundice is uncommon, occurring in less than 5% of cases, and can present with both direct and indirect hyperbilirubinemia. Because heterophile antibody tests may be negative in some patients, EBV-specific serology should be obtained when IM is suspected.<br /><br />The patient improved with supportive care and was discharged with outpatient follow-up. The report highlights the importance of considering EBV infection in young adults with unexplained jaundice, even when classic IM symptoms are absent, and stresses close monitoring due to rare but serious liver complications, including fulminant liver failure.

Asset Subtitle

Purnima Sharma

Meta Tag

Author List Hemanshi Mistry, Katerina Hanova, Purnima Sharma, Roberto Prieto, Rutul Dasharathlal Patel, Shruti Gupta, Sudhagar Thangarasu

Category Clinical Vignettes

Concept Epstein-Barr virus infectious mononucleosis

Concept Epstein-Barr Virus

Concept CD8 T Lymphocytosis

Concept Obstructive jaundice

Concept Hemolytic Anemia

Distinguished Non-Finalist

Presenter Organization Texas Tech Transmountain El Paso

Presenting Author Purnima Sharma

Track Adult

Keywords

Epstein-Barr virus

infectious mononucleosis

jaundice

cholestatic hepatitis

hemolytic anemia

direct antiglobulin test

adolescent

liver function abnormalities

reactive lymphocytes

EBV serology

Epstein-Barr virus infectious mononucleosis

Epstein-Barr Virus

CD8 T Lymphocytosis

Obstructive jaundice

Hemolytic Anemia