Positive later she presented with with acute pancreatitis

 Positive lab evidence for EBV in our patient is as follows :EBVcapsid Antigen –IgM was 152 units/mL(normal <40) and IgG -109units/mL(normal<20) were positive (CLIA quantitative method) indicatingacute primary Epstein-barr virus infection..

We performedserologic tests and magnetic resonance to exclude other viral or bacterialinfection, autoimmune disorder and cholangio-pancreatography to excludestructural problems. Review after two weeks was normal. One month later she presented with with acute pancreatitis &serum amylase and lipase were-457units/mL and 398units/mL respectively. Therewas no hepato-splenomegaly. She was managed conservatively. She becameasymptomatic in 4 days, serum amylase and lipase returned to normal.

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  .  Onfollow-up after eight weeks child was normal.DiscussionInfection-induced acute hepatitiscomplicated with acute pancreatitis is associated with hepatitis A virus,hepatitis B virus or hepatitis E virus. Although rare, Epstein-Barr virus (EBV)infection should be considered also in the differential diagnosis if thepatient has acute hepatitis combined with pancreatitis more so if they havefeatures of  infectious mononucleosis.Ka-Hyun Yoon and Jin-Bok Hwang reported acute pancreatitis in a 11-year-oldgirl without any clinical symptoms of infectious mononucleosis. It wasconfirmed by viral capsid antigen (VCA) IgM, VCA IgG, Epstein-Barr nuclearantigen and heterophile antibody test.

(1).Our case also has similar presentation.Pankaj jain ,et al reviewed 124 men with acute viral hepatitis, out of which 7patients were found to have acute pancreatitis(5.65%). The cause ofpancreatitis was hepatitis A virus in 2 patients, hepatitis E virus in 4patients, and hepatitis B virus in 1 patient.(2)The pancreatitis was mild and all haduneventful recovery from both pancreatitis and hepatitis. Lisa Kottanattu,et al have reported simultaneously seen acute pancreatitis in 14 and acalculouscholecystitis in 37 patients with primary acute symptomatic Epstein-Barr virusinfection. (3).

Hassib Narchi, et al reported hepatitisina 8 year old boy with acute pancreatitis.EBV infection was confirmed byelevatedS lipase of 1,000 IU/L (normal 30-210. alanine aminotransferase 182 IU/L aspartate aminotransferase 163 IU/L(normal 8- 20) and alkaline phosphatase 250 IU/L (normal 250-750 IU/L).) IgMfor EBV viral capsid antigen (EBV VCA) was positive confirming acute primaryEBV infection.

(4)Concurrent acute hepatitis and acutepancreatitis in a 25 year old male was documented by Jered Cook, et al who camewith 2-day history of abdominal pain, nausea and dark stools. EBV IgM antibodyto the viral capsid antigen and Epstein-Barr nuclear antigen was positive.     (5)Pancreatitis in a35-year-old woman with a 6-day history of fever and sore throat.

, vomiting,upper  abdominal pain and tenderness inepigastrium, and a macular rash across the upper trunk was reported byZen Zhu, et al. Serum amylase level of 1300 U/L  and lipase level of 1450 U/L .16%”atypical”lymphocytes on the blood film and, positive viral capsid antigen immunoglobulinM, negative viral capsid antigen immunoglobulin G (IgG), and EBV nuclearantigen IgG revealed EBV associated pancreatitis.(6)Go to:.Pancreatitis was even diagnosed after 3 weeks in a denguepatient by Rajesh, et al (7).Conclusion.

In a case of severe epigastric tendernesswith hepatitis, one must also consider a possibility of  EBV induced Acute Pancreatitis.. Primary acute pancreatitis due toEpstein-Barr virus infection is usually mild, and recovers fully.Recurrent pancreatitis is also a possibility.


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