Pediatr Gastroenterol Hepatol Nutr.  2013 Mar;16(1):61-64. 10.5223/pghn.2013.16.1.61.

Epstein-Barr Virus Infection with Acute Pancreatitis Associated with Cholestatic Hepatitis

Affiliations
  • 1Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea. pedgi@kmu.ac.kr

Abstract

Infection-induced acute hepatitis complicated with acute pancreatitis is associated with hepatitis A virus, hepatitis B virus or hepatitis E virus. Although rare, Epstein-Barr virus (EBV) infection should be considered also in the differential diagnosis if the patient has acute hepatitis combined with pancreatitis. We report a case of EBV infection with cholestatic hepatitis and pancreatitis with review of literature. An 11-year-old female was admitted due to 1-day history of abdominal pain and vomiting without any clinical symptoms of infectious mononucleosis. Diagnosis of reactivated EBV infection was made by the positive result of viral capsid antigen (VCA) IgM, VCA IgG, Epstein-Barr nuclear antigen and heterophile antibody test. We performed serologic tests and magnetic resonance cholangiopancreatography to exclude other viral or bacterial infection, autoimmune disorder, and structural problems. The patient's symptoms recovered rapidly and blood chemistry returned to normal with conservative treatment similar to previously reported cases.

Keyword

Cholestasis; Epstein-Barr virus; Hepatitis; Pancreatitis

MeSH Terms

Abdominal Pain
Bacterial Infections
Capsid
Cholangiopancreatography, Magnetic Resonance
Cholestasis
Diagnosis, Differential
Epstein-Barr Virus Infections
Female
Hepatitis
Hepatitis A virus
Hepatitis B virus
Hepatitis E virus
Herpesvirus 4, Human
Humans
Immunoglobulin G
Immunoglobulin M
Infectious Mononucleosis
Pancreatitis
Serologic Tests
Vomiting
Immunoglobulin G
Immunoglobulin M

Reference

1. Mishra A, Saigal S, Gupta R, Sarin SK. Acute pancreatitis associated with viral hepatitis: a report of six cases with review of literature. Am J Gastroenterol. 1999; 94:2292–2295. PMID: 10445566.
Article
2. Jain P, Nijhawan S, Rai RR, Nepalia S, Mathur A. Acute pancreatitis in acute viral hepatitis. World J Gastroenterol. 2007; 13:5741–5744. PMID: 17963301.
Article
3. Bhagat S, Wadhawan M, Sud R, Arora A. Hepatitis viruses causing pancreatitis and hepatitis: a case series and review of literature. Pancreas. 2008; 36:424–427. PMID: 18437090.
4. Huang GC, Chang CM, Ko WC, Huang YL, Chuang YC. Typhoid fever complicated by multiple organ involvement: report of two cases. J Infect. 2005; 51:E57–E60. PMID: 16038753.
Article
5. Kwak IS, Lee SB, Chung JS, Cho GJ, Rha HY. A case of candida fungemia in acute pancreatitis and hepatitis associated with typhoid fever. Korean J Med. 2000; 58:462–465.
6. Jung IS, Kim JW, Lim KS, Choi YM, Kong JM, Shu DR. A case of acute pancreatitis and hepatitis associated with typhoid fever. Korean J Intern Med. 1991; 41:119–122.
7. Kofteridis DP, Koulentaki M, Valachis A, Christofaki M, Mazokopakis E, Papazoglou G, et al. Epstein Barr virus hepatitis. Eur J Intern Med. 2011; 22:73–76. PMID: 21238898.
Article
8. Khawcharoenporn T, Lau WK, Chokrungvaranon N. Epstein-Barr virus infection with acute pancreatitis. Int J Infect Dis. 2008; 12:227–229. PMID: 17913534.
Article
9. Koutras A. Epstein-Barr virus infection with pancreatitis, hepatitis and proctitis. Pediatr Infect Dis. 1983; 2:312–313. PMID: 6310536.
Article
10. Mor R, Pitlik S, Dux S, Rosenfeld JB. Parotitis and pancreatitis complicating infectious mononucleosis. Isr J Med Sci. 1982; 18:709–710. PMID: 6286529.
11. Everett ED, Volpe JA, Bergin JJ. Pancreatitis in infectious mononucleosis. South Med J. 1969; 62:359–360. PMID: 5765134.
Article
12. Wislocki LC. Acute pancreatitis in infectious mononucleosis. N Engl J Med. 1966; 275:322–323. PMID: 5940698.
Article
13. Shimoda T, Shikata T, Karasawa T, Tsukagoshi S, Yoshimura M, Sakurai I. Light microscopic localization of hepatitis B virus antigens in the human pancreas. Possibility of multiplication of hepatitis B virus in the human pancreas. Gastroenterology. 1981; 81:998–1005. PMID: 6169587.
14. Basaranoglu M, Balci NC, Klör HU. Gallbladder sludge and acute pancreatitis induced by acute hepatitis A. Pancreatology. 2006; 6:141–144. PMID: 16354962.
Article
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