Jaundice and choluria as a presentation of infectious mononucleosis

One of the main clinical manifestations of Epstein-Barr virus infection is infectious mononucleosis, where mild hepatitis with a slight elevation of aminotransferases is observed in most cases. However, cholestatic hepatitis, characterized by jaundice, direct hyperbilirubinemia, elevated GGT and alkaline phosphatase, appears in less than 5% of patients with infectious mononucleosis. The present case showed jaundice and choluria as main findings, associating hypertransaminasemia, direct hyperbilirubinemia and elevated GGT. Serology and DNA detection confirmed acute Epstein-Barr virus infection. Acute Epstein-Barr virus infection should be included in the differential diagnosis of cholestatic hepatitis to avoid unnecessary diagnostics and treatments.