Ascites and Severe Hepatitis Complicating Epstein-Barr Infection

Epstein-Barr (EB) virus infection is common, with up to 90% of individuals demonstrating positive titers by age 20. Although elevated liver function tests commonly occur, severe hepatitis is rare. Only six cases of ascites complicating Epstein-Barr infection are reported, but none clearly demonstrate the absence of other causes of hepatic dysfunction. A 37-yr-old male presented with a 4-wk history of upper respiratory tract symptoms. Over 3 days before admission he developed jaundice and right upper quadrant pain. After hospitalization, the patient developed tense ascites requiring paracentesis. Serum-ascitic albumin gradient was 0.3 g/dL. Liver function tests peaked at the following values: prothrombin time of 24.5 s, total bilirubin of 18.0 mg/dL, and transaminases in excess of 5000 IU/L. EB Virus IgG and IgM titers were 1:640 and >1:40, respectively. Other viral serologies and polymerase chain reactions were negative. The patient experienced a complete clinical and laboratory recovery over the next 6 months. This represents the first documentation of ascites complicating Epstein-Barr infection without other sources of hepatic dysfunction. It demonstrates a narrow serum-ascitic albumin gradient in these patients, and that complete recovery can occur with supportive care.