Autoimmune hepatitis (HAI) is likely induced by Epstein Barr Virus (EBV) infection

Introduction and Objectives

HAI is an immune-mediated chronic inflammatory liver condition of uncertain etiology. There are genetic factors and triggering agents such as toxicity, infections, and medications, among others.

Case summary

An 18-year-old woman with nausea, vomiting, abdominal pain and jaundice, positivity for Hepatitis A IgM (IGM-HAV). PCR SARS COV 2 negative, creatinine 0.56, FA 297, GGT 463, DHL 756, INR 1.4 BT 5.32, BI 2.87, BD 2.45, ALB 3.57, AST 136, ALT 135, Hb 8.9, Neutrophils 500. Hematology concludes with hemophagocytic syndrome (SH). HCV AND HBV negative, IGG 1560, ANTI DNA 108, ANA 1:80, IGM-HAV reactive, EBV 29.9125 copies/ml. Cyclosporine is administered by SH. 10 months after she is assessed in the liver clinic for the persistence of transaminasemia. By ultrasound hepatosplenomegaly, without dilation of the bile duct. Liver biopsy reported inflammatory infiltrate of periportal predominance with interface activity, macrovesicular steatosis, without fibrosis, without hemophagocytosis, with biochemical and histological data compatible with HAI with a simplified score of 7 points. (Fig. 1).

Discussion

HAI is associated with positive autoantibodies, hypergammaglobulinemia and necro inflammatory features in histology. HAV and EBV can induce HAI, as it induces autologous antibodies against triose phosphate isomerase. The patient has complicated EBV infection with SH and persistence of IGM-HAV for 11 months. Liver biopsy with autoimmune hepatitis data, probably as a result of EBV infection and false positive for IgM-HAV for EBV coinfection.

Conclusion

A woman with EBV, probable false-positive HAV and EBV-induced HAI is reported.

Funding

The resources used in this study were from the hospital without any additional financing

Declaration of interest

The authors declare no potential conflicts of interest.

Figure 1. Liver histological cut with hematoxylin eosin 100x. predominantly lymphoid, moderate, portal inflammation with interphase and lobular activity in addition to moderate macrovesicular steatosis.