Ascites and severe hepatitis complicating Epstein-Barr infection

Epstein-Barr (EB) virus infection is common, with up to 90% of individuals demonstrating positive titers by age 20, Although elevated liver function t ests commonly occur, severe hepatitis is rare, Only six cases of ascites co mplicating Epstein-Barr infection are reported, but none clearly demonstrat e the absence of other causes of hepatic dysfunction. A 37-yr-old male pres ented with a 4-wk history of upper respiratory tract symptoms, Over 3 days before admission he developed jaundice and right upper quadrant pain. After hospitalization, the patient developed tense ascites requiring paracentesi s, Serum-ascitic albumin gradient was 0.3 g/dL. Liver function tests peaked at the following values: prothrombin time of 24.5 s, total bilirubin of 18 .0 mg/dL, and transaminases in excess of 5000 IU/L, EB Virus IgG and IgM ti ters were 1:640 and >1:40, respectively. Other viral serologies and polymer ase chain reactions were negative. The patient experienced a complete clini cal and laboratory recovery over the next 6 months. This represents the fir st documentation of ascites complicating Epstein-Barr infection without oth er sources of hepatic dysfunction. It demonstrates a narrow serum-ascitic a lbumin gradient in these patients, and that complete recovery can occur wit h supportive care. (C) 1999 by Am. Coll. of Gastroenterology.