EB病毒(EBV)的原发感染非常普遍,常表现为单核细胞增多综合征伴疲劳,喉咙痛,发烧,淋巴结肿大.在许多情况下发生肝脏受累,肝酶轻度升高。然而,以胆汁淤积性肝炎形式出现的EBV感染很少见.原发性EBV感染的另一种罕见并发症是噬血细胞性淋巴组织细胞增生症(HLH)。我们描述了一名原发性EBV感染患者,表现为疲劳和黄疸,随后的皮疹,和反应性淋巴细胞增多症。该患者被发现患有胆汁淤积性肝炎,根据实验室值高度怀疑患有HLH,包括升高的铁蛋白,甘油三酯,和白细胞介素-2水平.他显示使用地塞米松的HLH治疗的临床改善,依托泊苷,还有利妥昔单抗.我们进一步回顾了临床表现,发病机制,与EBV相关的胆汁淤积性肝炎和EBV-HLH的管理。强调原发性EBV感染的早期诊断,以正确识别和治疗可能危及生命的并发症。
Primary infection with Epstein-Barr virus (EBV) is very common, often manifesting as mononucleosis syndrome with fatigue, sore throat, fever, and enlarged lymph nodes. Liver involvement occurs in many cases with mildly elevated liver enzymes. However, it is rare to see EBV infection present as cholestatic hepatitis. Another rare complication of primary EBV infection is hemophagocytic lymphohistiocytosis (HLH). We describe a patient with primary EBV infection who presented with fatigue and jaundice, subsequent rash, and reactive lymphocytosis. The patient was noted to have cholestatic hepatitis and was highly suspected to have HLH based on laboratory values, including elevated ferritin, triglyceride, and interleukin-2 levels. He showed clinical improvement with HLH treatment using dexamethasone, etoposide, and rituximab. We further review the clinical manifestations, pathogenesis, and management of EBV-associated cholestatic hepatitis and EBV-HLH. Early diagnosis of primary EBV infection is emphasized in order to properly recognize and treat potentially life-threatening complications.