A 40-year-old male, with no toxic habits, with a history of dyslipidemia and echographic hepatic steatosis, was admitted to our hospital due to a clinical picture of jaundice and impaired hepatic biochemistry two days after admission.
Fifteen days before, she had suffered a flu-like reaction in the form of fever, arthralgia, dry cough and headache, for which she was treated with paracetamol, ibuprofen and a herbal product containing valerian.
The physical examination revealed obesity and the presence of mucocutaneous jaundice, without stigmata of chronic liver disease.
The patient developed hepatomegaly 2 cm from the right costal margin, without stenosis or adenopathies.
Laboratory studies showed the following results: Hb: 15.5 g/dl; platelets: 324,000/mm3; leukocytes: 11,4003 ALT: peripheral bilirrubin UBR; alkaline glycaemia: 1690 cholesterol:
The study of autoimmunity and metabolic causes of liver disease was negative.
These were also the serologies of hepatitis A, B and C viruses, including HCV RNA.
Serology of old cytomegalovirus (IgG) infection and IgM-antibodies against EBV capsid (ECV) were positive, with nuclear antibodies negative for this-IgG virus.
Abdominal ultrasound showed signs of fatty liver, without bile duct dilatation or lithiasis.
The laboratory evolution was favorable, but one month after admission there were still persistent biochemical signs of stasis, which is why a percutaneous liver biopsy was performed.
Histology showed a liver tissue with preserved architecture, although with slight portal fibrous expansion, and inflammation in portal tracts in the form of mixed infiltrate consisting of lymphocytes, eosinophils, plasma cells and larger active lymphoid cells.
This infiltrate exceeded the periportal limiting trabeculae.
The lobule also presented an inflammatory infiltrate of lymphocytes of normal size, arranged in an "Indian line".
There were degenerative changes in liver cells, such as acidophilic bodies and hydropic changes, as well as hyperplasia of macrophages Küpffer.
Less than 10% of hepatocytes showed macrovacuolae strictures.
The histological picture corresponded to a "lobular and periportal hepatitis pattern compatible with acute hepatitis, without definitive morphological signs of etiology".
In situ hybridization for EBER ("Epstein-acquired virus encoded RNA") was performed, which was positive in activated lymphocytes.
