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A Rare Presentation of Epstein-Barr Virus Infection. J Emerg Med 2020 Feb;58(2):e71-e73

Date

01/25/2020

Pubmed ID

31973958

DOI

10.1016/j.jemermed.2019.11.043

Scopus ID

2-s2.0-85078073328 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

BACKGROUND: Epstein-Barr virus (EBV) is a herpesvirus spread by intimate contact. It is known to cause infectious mononucleosis. Complications, including hematologic pathology and splenic rupture, are uncommon. This report is a case of EBV-induced autoimmune hemolytic anemia and biliary stasis.

CASE REPORT: An 18-year-old man presented to the emergency department with abdominal pain, nausea, vomiting, and jaundice. He did not have risk factors for liver injury or hepatitis. His vital signs were notable for a fever. On examination, he was obviously jaundiced, but not in distress. Laboratory evaluation showed hemolytic anemia and biliary stasis. Ultimately, his inpatient workup yielded positive EBV serology and a positive direct agglutinin test with cold agglutinins. He made a full recovery with supportive care. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: EBV is a widely disseminated herpesvirus. Infectious mononucleosis is a common presentation of acute infection, and treatment of EBV-related diseases are largely supportive. Complications, such as splenic rupture and hematologic pathology, are uncommon. Biliary stasis and autoimmune hemolytic anemia in the form of cold agglutinin disease secondary to EBV is rare, and typically resolves with supportive care and cold avoidance. More advanced treatment methods are available in the setting of severe hemolysis. Elevated transaminases, direct hyperbilirubinemia, or evidence of hemolytic anemia in the setting of a nonspecific viral syndrome should raise suspicion for EBV infection. Rapid recognition can lead to more prompt prevention and treatment of other EBV-related complications.

Author List

Teijido J, Tillotson K, Liu JM

Author

Jason M. Liu MD Professor in the Emergency Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Anemia, Hemolytic, Autoimmune
Cholestasis
Diagnosis, Differential
Epstein-Barr Virus Infections
Humans
Male