Hepatitis Without Jaundice in Infectious Mononucleosis

JAUNDICE was first recognized as a complication of infectious mononucleosis by Mackey and Wakefield in 1926.1A single case in which a patient with this disease exhibited jaundice had been noted previously by Downey and McKinlay.2The incidence of jaundice in different reported series of cases of infectious mononucleosis has varied from 1.3 to 12.8 per cent.3At first, it was postulated that jaundice was due to blocking of the common duct by enlarged lymph glands.4Later evidence acquired by tests of hepatic function5and by biopsies of material obtained with the punch6indicates that jaundice is secondary to parenchymatous changes in the liver. From a single biopsy of the liver, Kilham and Steigman6adescribed a well defined focal acute hepatitis. They said: "the maximum change is seen in the portal tracts of the lobules where there is loss of liver cells and a well developed histiocytic