A Case Report of Autoimmune Haemolytic Anaemia and Acute Hepatitis Associated With Epstein-Barr Virus Infection

Infectious mononucleosis is most commonly caused by Epstein-Barr virus (EBV) infection. Although mild hepatic dysfunction is commonly seen, clinically significant acute hepatitis and autoimmune haemolytic anaemia (AIHA) are not seen routinely in clinical practice. The concurrent presentation of both of these poses a diagnostic challenge. A 22-year-old woman presented with jaundice and fatigue following a recent viral illness; she was found to have significant hepatic dysfunction with a peak bilirubin of 344 µmol/L and haemoglobin nadir of 64 g/L. A positive direct antiglobulin test, with blood film findings, supported the diagnosis of AIHA. EBV serology confirmed acute or recent EBV infection, providing a unifying diagnosis. She was managed supportively with no corticosteroids or blood transfusion, under close monitoring and with advice from the haematology team. Her liver function tests and haemoglobin gradually normalised, and follow-up ultrasound demonstrated resolution of splenomegaly. This case highlights the importance of considering EBV for a potential underlying, unifying diagnosis for patients presenting with both AIHA and hepatitis, particularly following a viral prodrome and when other causes have been excluded. Ensuring appropriate haematological investigations are undertaken is essential to guide appropriate management and monitoring.