A young female w/ history of Crohn’s (in remission) presented with RUQ and fever after a URI, found to have ALI + neutropenia and atypical lymphocytes on smear. She was initially treated for acute cholecystitis but imaging showed only splenomegaly; she was ultimately diagnosed with EBV as the cause!
What are the most common GI manifestations of EBV?
*NINETY PERCENT (90%!) of people with EBV get some LFT abnormalities – these can be predominantly hepatocellular (elevated transaminases) OR cholestatic (elevated alk phos and bili)
*Splenomegaly occurs in ~ 50% of individuals
How do you test for acute EBV?
*The first line test should be the heterophile antibody – it is highly specific in the right clinical setting (i.e. classic malaise, LAD, sore throat) but somewhat insensitive.
*In an atypical clinical setting, or if high suspicion for EBV but negative heterophile antibody, it is reasonable to test EBV-specific antibodies. +IgM with (-)IgG is consistent with acute infection.
When do you treat EBV with antivirals?
There is really not data that shows acyclovir has significant clinic benefit over placebo; treatment remains supportive. If you’re even thinking about treating, ID and (in this case) GI should be involved.