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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
From the Departments of Medicine (Drs Gill, Kravitz, and Tombers) and Pathology (Drs Fuhrman and Horwitz), Mount Sinai and St John's Hospitals and the Park-Nicollet Medical Center, Minneapolis-St Paul; Department of Pathology, the Fargo (ND) Clinic (Dr Baldwin); and the Joseph Stokes Jr Research Institute of the Children's Hospital of Philadelphia (Drs W. Henle and G. Henle).

Footnotes
Accepted for publication Nov 18, 1986.

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

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