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Analysis of Laboratory Data in Seven Patients

Susan A. Fuhrman, MD; Robert Gill, MD; Charles A. Horwitz, MD; Wener Henle, MD; Gertrude Henle, MD; Gary Kravitz, MD; Jerry Baldwin, MD; Joseph Tombers, MD

Arch Intern Med. 1987;147(5):850-853.

Abstract

• While mild to moderate hepatic dysfunction is commonly encountered in infectious mononucleosis induced by Epstein-Barr virus (EBV), clinical jaundice with high bilirubin levels (6.0 mg/dL [103 µmol/L]) is only occasionally encountered. In this study, seven patients with primary EBV infections had peak bilirubin levels of 10.2 to 23.0 mg/dL (174 to 393 µmol/L) and, for the most part, presented initial diagnostic problems. Complications included the virus-associated hemophagocytic syndrome and acute respiratory distress syndrome in one patient and transient renal failure in another. The laboratory data suggested that a combination of hemolysis and viral-induced cholestasis was responsible for the intense hyperbilirubinemia in at least five patients. Physicians should be aware that marked hyperbilirubinemia can occur with EBV-induced infectious mononucleosis and, thereby, obviate the need for costly diagnostic laboratory tests and, occasionally, invasive procedures.

(Arch Intern Med 1987;147:850-853)

Author Affiliations

Footnotes

Reprint requests to Mount Sinai Hospital, 2215 Park Ave, Minneapolis, MN 55404 (Dr Fuhrman).

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