Cholestatic Hepatitis Secondary to Epstein-Barr Virus Infection in Children: Case Series and Review of the Literature

Objective Cholestatic hepatitis (CH) secondary to Epstein-Barr virus (EBV) infection is a rare clinical condition in children and adolescents, which was reported in 5% of patients. Herein, we aimed to present our pediatric cases of EBV-induced CH with a comprehensive review of previously reported patients. Methods Three cases of EBV-induced CH diagnosed in our department were included in the study. EBV diagnosis was established with positive viral capsid antigen immunoglobulin M and immunoglobulin G. A search of English literature on pediatric cases with EBV-induced CH was conducted on common search engines (PubMed and GoogleScholar). Results We report three novel cases (aged 6, 15, and 16 years) presented with infectious mononucleosis and jaundice. The physical examination revealed mild hepatomegaly in all of them. In our cases, a total of 21 pediatric patients with EBVinduced CH were reported until now (52.4% male), with a median age of 15 (1-18) years. Regarding all patients, the most common symptoms were fever (94.1%) and jaundice (84.6%). In laboratory results, aspartate aminotransferase [308 (62-2,148) IU/L]. alanine aminotransferase [312 (79-899) IU/L], and gamma-glutamyl transpeptidase [328.9 = 198.6 IU/L] levels were elevated. Hyperbilirubinaemia was observed in all cases with a median direct bilirubin level of 3.9 (1.9-21.8) mg/dL. A thickened gallbladder wall was the most common (50%) finding in the abdominal ultrasonography of the cases. Most of the reported patients recovered under supportive treatment without any further morbidity. Conclusions Although EBV-induced CH is an atypical presentation for children, it should be considered in the differential diagnosis of cholestasis. Supportive therapies are the mainstay of treatment in most of these cases.