We report the case of a 15-year-old woman with no relevant personal history and no risk factors for liver disease.
Initially she presented headache, odynophagia, cervical lymphadenopathy, parpebral edema and fever of 39 oC.
On the fourth day of evolution she was admitted, and laboratory tests (day 0) were performed, without alterations, hemocultives that were negative, and viral serology, with heterophile antibodies (Paul Bunnell virus) and IgM (CMV.
At 72 hours, the patient began with abnormal liver biochemistry: AST 270 U/l (10-37), ALT 233 U/l ratio (10, 1.3), alkaline hemoglobin (Hb) 2,311.8 mg/dl (GGT) 110.1-15ata 10
The patients transplant 2,1dl together with a torpid form with marked rise in bilirubin up to 14,8 mg/dl (direct b 13,8 mg/dl), which was due to a possible decrease in Hb: 8,9 g/dl
Abdominal ultrasound showed small ascitic fluid and marked stenosis.
The etiologic study included serology of hepatotropic virus (HAV, HBV, HCV [viral load], herpes simplex virus, herpes virus 6, EBV, Leishmania infection), human immunodeficiency virus (HIV), bacteria (R.
The peripheral blood smear showed normocytic anemia with activated lymphocytes and hemolysis data, with positive direct Coombs test for cryoagglutinins.
The hematologic study concluded with bone marrow biopsy that ruled out macrophage activation.
Simultaneously, EBV determination in blood was requested by PCR (polymerase chain reaction), which was positive, with a viral load of 62,445 cops/ml, showing a posteriori seroconversion IgM and IgG seroconversion.
Treatment was started with methotrexate (10 mg/kg/8h IV) and prednisone (60 mg/24 PO) 13 days after the onset of symptoms.
Progressively from the beginning of empirical therapy, liver function parameters as well as anemia improved.
After ten days of antiviral treatment, virologic response five days later and valvulavir therapy five days later (1,000 mg/8 h PO), together with prednisone in descending order, progressive analytical improvement was observed, as shown in Table I.
