Silent Invader: A Case of Primary EBV Hepatitis in an Immunocompetent Adult

Epstein-Barr virus is primarily known to cause infectious mononucleosis, predominantly during adolescence. By adulthood, more than 90% of individuals have antibodies to the virus. One rare manifestation of Epstein-Barr virus is symptomatic hepatitis, which is only seen in 10% of the population. We present a case of infrequently seen primary Epstein-Barr virus hepatitis in a 48-year-old male who initially presented with periorbital jaundice. Diagnosis was confirmed by obtaining a liver biopsy that demonstrated B-cells positive for EBER-ISH (Epstein-Barr encoding region in situ hybridization), the methodology of choice for detection of the virus. The intent of this case report is to highlight the intriguing manifestation of symptomatic hepatitis secondary to Epstein-Barr virus. Clinicians should have a high level of suspicion for patients who present with jaundice, transaminitis and classic infectious mononucleosis symptoms. Understanding the breadth of the disease process requires recognizing that this virus can manifest in myriad ways.