Dosanjh Harpreet S, Dosanjh Primala K, Ipalawatte Harendra, Mehdi Zain
Internal Medicine, Los Robles Regional Medical Center, Thousand Oaks, USA.
Cureus. 2025 Jun 30;17(6):e87066. doi: 10.7759/cureus.87066. eCollection 2025 Jun.
Epstein-Barr virus (EBV) infection is a common viral illness typically presenting with symptoms such as fever, sore throat, and lymphadenopathy. Hepatic involvement in EBV infection is usually mild and transient. However, severe cholestatic liver disease due to acute EBV hepatitis is rare, especially in young adults. Secondly, hemophagocytic lymphohistiocytosis (HLH), the abnormal activity of lymphocyte function leading to hemophagocytosis and multi-organ failure, is a rare complication of EBV. In the context of Los Angeles County, the locale of this study, the incidence of secondary nonfamilial HLH among patients over the age of 15 is reported at 0.9 cases per million annually, with epidemiological data specific to EBV-associated HLH even more notably limited. We report a case of a 20-year-old female patient presenting with fever and chills, ultimately diagnosed with acute EBV hepatitis causing severe cholestatic liver injury, with concurrent positive antimitochondrial antibody and HLH, without multi-organ failure, who showed significant improvement with the administration of N-acetylcysteine (NAC), highlighting its potential therapeutic role in EBV-associated liver diseases.
爱泼斯坦-巴尔病毒（EBV）感染是一种常见的病毒性疾病，通常表现为发热、喉咙痛和淋巴结病等症状。EBV感染引起的肝脏受累通常较轻且为一过性。然而，急性EBV肝炎导致的严重胆汁淤积性肝病较为罕见，尤其是在年轻成年人中。其次，噬血细胞性淋巴组织细胞增生症（HLH）是淋巴细胞功能异常导致噬血细胞作用和多器官衰竭的一种疾病，是EBV感染的一种罕见并发症。在本研究开展地点洛杉矶县，15岁以上患者继发性非家族性HLH的发病率据报道为每年每百万人口0.9例，而关于EBV相关HLH的流行病学数据更为有限。我们报告一例20岁女性患者，出现发热和寒战，最终诊断为急性EBV肝炎导致严重胆汁淤积性肝损伤，同时抗线粒体抗体阳性且并发HLH，但未出现多器官衰竭，给予N-乙酰半胱氨酸（NAC）治疗后病情显著改善，突出了其在EBV相关肝病中的潜在治疗作用。
