Epstein-Barr Virus (EBV) Hepatitis Treated With N-Acetylcysteine: Placebo Versus True Effect

Epstein-Barr virus (EBV) is a herpesvirus that is known to cause multiple conditions, ranging from malignancies like Hodgkin and non-Hodgkin lymphomas to infectious and autoimmune conditions like infectious mononucleosis and systemic lupus erythematosus. Infectious mononucleosis causes systemic symptoms including cervical lymphadenopathy, splenomegaly, malaise, myalgias, and fever. While the spleen and liver are involved in some cases, most cases result in mild elevation of transaminases, not exceeding two to three times the upper normal limit. The transaminitis is usually subclinical with a self-limiting course. On rare occasions, liver involvement is associated with significant transaminitis reaching up to 10 times the upper normal limit. These patients usually also present with jaundice. Such severe or fatal hepatitis is most commonly seen in immunocompromised individuals. Here, we present a 31-year-old man who came to us with progressive jaundice, upper quadrant abdominal pain, and greasy stools after what he thought was just the flu. The patient was found to have EBV-induced hepatitis, requiring N-acetylcysteine administration.