Jasmina Skoric, Bojan Pavković


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.


antibodies, hepatitis, biopsy, Epstein-Barr virus

Full Text:



Womack J, Jimenez M. Common questions about infectious mononucleosis. Am Fam Physician, 2015; 15;91(6):372-6.

Dunmire SK, Hogquist KA, Balfour HHJ. Infectious Mononucleosis. Curr Top Microbiol Immunol. 2015; 390)Pt 1): 211–40. doi: 10.1007/978-3-319-22822-8_9.

Peng H, Lim T, Nam J, Lee J. Autoimmune hepatitis following Epstein-Barr virus infection: a diagnostic dilemma.BMJ Case Rep. 2019 ;12(7):e229615. doi: 10.1136/bcr-2019-229615.

Alvarez F. Autoimmune hepatitis in children. J Pediatr (Rio J). 2019;95(4):382-4. doi: 10.1016/j.jped.2018.08.001.

Della Corte C, Mosca A, Vania A, Alterio A, Alisi A, Nobili V. Pediatric liver diseases: current challenges and future perspectives. Expert Rev Gastroenterol Hepatol. 2016;10(2):255-65. doi: 10.1586/17474124.2016.1129274.

Salih MM, Ibraheem MF, Nader KE. Etiology and clinical pattern of liver diseases in children. JFac Med Bagdad. 2018; 60(2):76-9.doi: 10.32007/jfacmedbagdad.6028.

Houldcroft CJ, Kellam P. Host genetics of Epstein–Barr virus infection, latency, and disease. Rev Med Virol. 2015 Mar; 25(2): 71–84. doi: 10.1002/rmv.1816.

Liberal R, Vergani D, Mieli-Vergani G. Update on autoimmune hepatitis . J Clin Transl Hepatol. 2015;3(1):42-52. doi: 10.14218/JCTH.2014.00032.

Rigopoulou EI, Smyk DS, Matthews CE, Billinis C, Burroughs AK, Lenzi M, et al. Epstein-barr virus as a trigger of autoimmune liver diseases. Adv Virol. 2012;2012:987471. doi: 10.1155/2012/987471.

Porta G, Carvalho E, Santos J, Gama J, Borges CV, Seixas RBPM, et al. Autoimmune hepatitis in 828 Brazilian children and adolescents: clinical and laboratory findings, histological profile, treatments, and outcomes. J Pediatr (Rio J). 2019;95(4):419-27. doi: 10.1016/j.jped.2018.04.007.



  • There are currently no refbacks.

Copyright (c) 2021 Jasmina Skoric, Bojan Pavković

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.