INFECTIOUS MONONUCLEOSIS AND AUTOIMMUNE HEPATITIS

Abstract

Introduction: The case report shows a sick nine-year-old girl whose disease initially manifested as infectious mononucleosis. Encountering infectious mononucleosis in pediatrics is quite common and it is estimated that as much as 50% of children are infected with the Epstein-Barr virus before the age of 5. Suspicion of mononucleosis emerges every time there is a patient with swollen neck lymph nodes, fever, painful and difficult swallowing. However, the laboratory findings in the second month of the onset of the disease raised suspicion for autoimmune disease.

Case report: Based on the clinical manifestations, the patient underwent a series of examinations such as biochemical analyses, blood count, and Epstein-Barr virus serology, as well as abdominal ultrasound and testing of ceruloplasmin and Alpha-1 antitrypsin values. The autoimmune disorder was confirmed after detecting elevated IgG levels, the presence of anti-LKM antibodies, and interface hepatitis as a pathoanatomic substrate of liver bioptates.

Conclusion: The case report presents the Epstein-Barr virus as a direct trigger of autoimmune hepatitis. This DNA virus known for its cytopathic effect on B lymphocytes induced the swelling of lymph nodes, liver, and spleen. Its overall impact on B lymphocytes and the liver led to producing specific autoantibodies and infiltrating hepatic nodes with lymphocytes.