A Rare Case of Epstein-Barr Virus Hepatitis and Rash in an Adolescent.

Infection from Epstein-Barr virus (EBV) manifests with a diverse spectrum of presentations. One common manifestation is hepatobiliary involvement with hepatitis, which in most cases is mild and self-limited. Severe or fulminant hepatitis can potentially occur, though this is rare, particularly in immunocompetent pediatric populations. We present a previously healthy female adolescent with severe abdominal pain and jaundice, but no lymph node or tonsillar swelling. The workup revealed a marked elevation in liver enzymes, bilirubin, and mesenteric adenitis. A positive polymerase chain reaction (PCR) for EBV confirmed the diagnosis of EBV hepatitis and cholestasis. The patient was primarily managed supportively, including intravenous (IV) hydration. During her treatment course, she developed a diffuse maculopapular rash of uncertain etiology, which gradually self-resolved. We review similar cases reported in the literature, as well as potentially life-threatening complications of EBV infection. It is therefore prudent to consider EBV hepatitis in patients with abdominal pain and transaminitis, even in the absence of immunocompromise or classic mononucleosis symptoms.