Acute Epstein-Barr Virus Hepatitis With Cholestatic Jaundice and Hyperferritinaemia: A Case Report

Epstein-Barr virus (EBV) is a common human pathogen often associated with infectious mononucleosis (IM), a typically self-limiting illness. EBV can affect the liver, with manifestations ranging from asymptomatic hepatitis to acute liver failure, particularly in immunocompromised individuals. Cholestatic jaundice and marked hyperferritinaemia are rare in EBV hepatitis, with ferritin levels correlating with disease severity. We report a case of EBV hepatitis in a 50-year-old immunocompetent man presenting with cholestatic jaundice, pharyngitis, cervical lymphadenopathy, and hyperferritinaemia (ferritin 5384 μg/L). Liver biochemistry showed elevated transaminases (alanine transaminase 190 U/L, aspartate transaminase 310 U/L), hyperbilirubinaemia (92 μmol/L), and cholestasis (alkaline phosphatase 902 U/L, gamma-glutamyl transferase 941 U/L). Atypical lymphocytes were seen on peripheral blood smear. Acute EBV infection was confirmed by the presence of EBV Immunoglobulin M (IgM) antibodies, and the patient was successfully managed in an ambulatory care setting with supportive treatment.