All issues > Volume 37(8); 1994

Original Article

J Korean Pediatr Soc. 1994;37(8):1124-1135. Published online August 15, 1994.

Epstein-Barr Viral Hepatitis in Childhood

Soo Kyung SK Lee¹, Ki Sup KS Chung¹

¹Department of Pediatrics, Yonsei University, College of Medicine, Seoul, Korea

Abstract

We analysed 58 patients who were admitted to the Department of Pediatrics, yonsei University College of Medicine due to infectious mononucleosis from January 1986 to August 1992. Of 58 patients who had responses to IgM to EBV viral capsid antigen and/or heterophil antibody, 35 patients had hapatitis. Of 35 hepatitis patients, group I consisted of 22 patients who had only EBV infection and group II consisted of 13 patients who had hepatitis B markers or cytomegaloviral markers. The results were as follows: 1) Sex distribution revealed males to females to be 1.1:1. In the age distribution, the proportion of patients with 1 to 3 years of age occupied 40.9% for group I and 30.8% for group II. In non-hepatitis group, 73.9% of patients were in 2 months to 3 years of age. 2) The common presenting symptoms and signs of hepatitis group included hepatomegaly in 24 cases (68.6%), fever in 19 (54.3%), anorexia in 17 (48.6%), throat injection in 16 (45.7%), splenomegaly in 5 (42.9%), and cervical lymphadenopathy in 10 cases (28.6%) etc. 3) In group I, complications or combined diseases included pneumonia in 4 case, disseminated intravascular coagulation in 2 and 1 case in acute pancreatitis. Group II included 1 case of iron deficiency anemia, acute renal failure, peritonitis and pulmonary hemorrhage respectively. 4) Anemia (Hb: <10g/dl) was found in 3 cases (13.6%) for group I, and in 2 cases (15.4%) for group II. Leukocytosis above 10,000/mm3 was demonstrated in 15 cases(68.2%) for group I and in 3 cases (23.1%) for group II. The higher percentage (>15%) of atypical lymphocytes were found in 3 cases(13.6%) for group I and in 1 case (7.7%) for group II. Thrombocytopenia (platelet: <100,000/mm3) was detected in 1 case(4.5%) for group I and in 3 cases (23.1%) for group II. Total bilirubin above 1.0mg/dl was found in 6 cases (27.3%) for group I and in 5 cases (58.1%) for group II> 5) AST level of 100~500 IU/L was found in 10 cases (45.4%) for group I, and in 5 cases (38.5%) for group II. AST level above 500 IU/L was demonstrated in 1 case (4.5%) and in 3 cases (23.1%) respectively. The mean values of AST level were 253.4?55.3 IU/L and 316.7?02.4 IU/L, respectively. 6) Elevated ALT level of 100~500 IU/L was found in 9 cases (40.9%) for group I and in 9 cases(69.2%) for group II. ALT level above 500 IU/L was detected in 5 cases (22.7%) for group I and in 3 cases (15.4%) for group II. The mean values of ALT level were 356.9?61.2 IU/L and 308.3?59.1 IU/L, respectively. 7) Elevated ALT levels returned to normal values within 3 weeks in 14 cases (82.4%) for group I and in 6 cases (66.7%) for group II. The mean duration of normalization of ALT level were 17.3?4.1 days for group I and 19.9?4.8 days for group II. Our results suggest that if AST/ALT levels are elevated and hepatitis A, B, C markers are negative, or if sudden elevated AST/ALT levels are noted in hepatitis B carriers or a patient with cytomegaloviral hepatitis, Epstein-Barr virus infection should be suspected.

Keywords :Epstein-Barr virus, Hepatitis, EBV-VCA IgM, Infectious mononucleosis