Characteristics of Epstein-Barr virus hepatitis among patients with jaundice or acute hepatitis

Background Abnormal liver blood tests are common in EpsteinBarr virus (EBV) infection, but symptomatic hepatitis is rare. The demographics, clinical features and outcome of EBV hepatitis are incompletely understood, particularly in the elderly people. Aim To identify the demographics, presenting features and natural history of EBV hepatitis. Methods Retrospective review of 1995 consecutive patients attending the jaundice hotline clinic over a 13-year period. Data collected included demographic information, presenting features, clinical and laboratory parameters, radiology imaging and clinical outcome. Results Seventeen of 1995 (0.85%) had EBV hepatitis. The median age was 40years (range 1868years). Ten of 17 (59%) patients were aged >30years, and seven of 17 (41%) patients were aged =60years. Fifteen of 17 (88%) patients presented with clinical/biochemical evidence of jaundice. Seventeen of 17 (100%) patients had a serum lymphocytosis at presentation. 2/17 (12%) patients with EBV hepatitis presented with the classical features of infectious mononucleosis (fever, sore throat and lymphadenopathy). Splenomegaly was present in 15/17 (88%) of patients. Symptoms lasted for a median 8weeks (range 112weeks). Three of 17 (18%) patients required a brief hospital admission. Conclusions In patients presenting with jaundice/hepatitis, EBV hepatitis is an uncommon diagnosis and causes a self-limiting hepatitis. The diagnosis is suggested by the presence of a lymphocytosis and/or splenomegaly. The majority of patients do not have infectious mononucleosis. Compared with infectious mononucleosis, EBV hepatitis affects an older age group, with nearly half of patients being aged more than 60years. The diagnosis should be considered in all patients with unexplained hepatitis irrespective of their age.