Epistein-Barr Virus Infection with Concurrent Pancreatitis and Hepatitis: A Rare Disease Entity

Concurrent acute hepatitis and acute pancreatitis is a rare disease entity. Most commonly it can be attributed to infectious etiologies such as hepatitis A, Hepatitis B and Hepatitis E. Although not as common, Epstein Barr Virus (EBV) should be considered in the differential diagnosis in patients with combined hepatitis and pancreatitis. We report a case of a 25 year-old male admitted with 2-day history of abdominal pain, nausea and dark stools. Laboratory findings were significant for mixed hepatocellular and cholestatic liver injury. Abdominal imaging showed evidence of acute pancreatitis, without biliary obstruction. Serologic tests and radiologic imaging excluded common infectious, autoimmune and/or structural etiologies. The diagnosis of EBV infection was made by a positive IgM antibody to the viral capsid antigen and Epstein-Barr nuclear antigen. The patient had a prolonged hospitalization for persistent abdominal pain and lag in improvement in his cholestatic liver injury. This disease process has been described in 6 children and no cases in adults have been reported to our knowledge.