Cholestatic Hepatitis: A Rare Manifestation of Infectious Mononucleosis

One of the main clinical manifestations of infection by the Epstein-Barr virus (EBV) is infectious mononucleosis. In this clinical syndrome, mild hepatitis with a slight elevation of aminotransferases is common. However, cholestasis is rare and usually occurs alongside a more severe, cytolytic hepatitis. This case report describes a 26-year-old male admitted to the emergency service with recurrent fever, odynophagia, and painful cervical lymphadenopathy, along with a skin rash after starting treatment with amoxicillin/clavulanate, and jaundice. The analytical assessment was consistent with cholestatic hepatitis, and the abdominal CT scan revealed hepatosplenomegaly. The diagnosis of EBV infection was confirmed by the presence of serological markers. This case aims to raise awareness of a rare manifestation of a common infectious agent in order to consider acute EBV infection in the differential diagnosis of cholestatic hepatitis in adult patients.