Severe hepatitis caused by Epstein-Barr virus without infection of hepatocytes

Although hepatitis is a common feature of primary Epstein-Barr virus (EBV) infection, severe liver injury is rare and its pathogenesis is unclear. A p reviously healthy girl developed severe hepatitis with prolonged jaundice. Serologic examination showed that she had primary infection with EBV. An ex tremely high Epstein-Barr viral load was observed in her peripheral blood. The viral load decreased in parallel with symptomatic improvement. Histolog ic examinations showed spotty necrosis of the liver parenchyma and infiltra tion by CD8(+) T cells. The CD8(+) T cells, not hepatocytes, were positive for EBV. Possible mechanisms of viral hepatitis without infection of hepato cytes are discussed. Hum PATHOL 32:757-762. Copyright (C) 2001 by W.B. Saun ders Company.