P2951 - A Rare Case of Epstein-Barr Virus-Induced Acute Liver Injury

Ademayowa Ademiluyi, MD, Dominic Amakye, MBBCh, Nicola Jackson, MD, Shion Betty, MD
Piedmont Athens Regional Medical Center, Athens, GA

Introduction: Epstein-Barr Virus infection can involve several organs in the body including the liver and can subsequently result in acute liver failure in extremely rare cases. EBV induced ALF accounts for < 1% of all cases of ALF. The diagnosis is confirmed by either EBV serology or tissues biopsy. Treatment is mainly supportive with liver transplantation in a few select cases if indicated. Here we describe a patient who we managed for EBV induced acute liver injury.

Case Description/Methods: 75 y/o man with a PMH of alcohol abuse disorder and hypertension presents with 2 days history of abdominal pain. He described the abdominal pain as generalized, sharp, with intensity of 7/10 with no alleviating or exacerbating factors. It was associated with nausea and vomiting. Patient had significant alcohol intake with consumption of 1 pint of gin daily for the past 10 years. His last alcohol drink was 3 weeks before presentation. He denied consumption of moonshine or mushrooms. He denied fever, chills, sore throat, melena, hematochezia and history of STDs. On presentation, vital signs were normal. Physical examination was remarkable for generalized tenderness and hepatomegaly with normal bowel sounds. There was no lymphadenopathy, jaundice, palmar erythema or asterixis. Laboratory analysis revealed hemoglobin of 12.2, platelet of 20,000. AST >1000, ALT > 500, alkaline phosphatase 130, total bilirubin 3.1, albumin 3.3 and INR of 4.33. Ferritin >7500, Hepatitis panel was non-reactive. Autoimmune workup was unremarkable. EBV IgM was negative, EBV IgG was elevated at >750 and EBV DNA PCR was elevated at 3.56 copies/ml. Acetaminophen level was normal. Right upper quadrant ultrasound showed only diffusely increased hepatic echogenicity. He briefly received N-acetyl cystine. He received supportive treatment with normal saline hydration. T. bilirubin peaked at 7.7 with direct bilirubin of 5.1 on day 6 of admission. Subsequently, liver enzymes trended down and his symptoms resolved completely.

Discussion: Hepatic involvement of EBV infections is common although subclinical and self-limiting. In majority of cases, there are mild elevations in transaminases. EBV infections on rare occasions can lead to acute hepatitis and fulminant hepatic failure especially in the elderly. EBV induced ALF in immunocompetent adults is even rarer. Like our patient, after ruling out the common etiologies of ALF, most patients recover with supportive management. There is a role for liver transplantation for patients who do not improve.


Disclosures:
Ademayowa Ademiluyi indicated no relevant financial relationships.
Dominic Amakye indicated no relevant financial relationships.
Nicola Jackson indicated no relevant financial relationships.
Shion Betty indicated no relevant financial relationships.


Ademayowa Ademiluyi, MD, Dominic Amakye, MBBCh, Nicola Jackson, MD, Shion Betty, MD. P2951 - A Rare Case of Epstein-Barr Virus-Induced Acute Liver Injury, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.