Usually, the most common gastrointestinal presentation of IM is hepatosplenomegaly with derangement in LFT's, which is symptomatically treated with avoidance of contact sports for a few weeks. As a result, he was symptomatically treated and discharged home with close follow-up with his PCP. The patient had no preceding upper respiratory symptoms including pharyngitis or posterior cervical lymphadenopathy. Viral workup including HIV, CMV IgM Abs, Viral Hepatitis panel and Monospot were performed, which were unremarkable except for a positive Monospot.Other non-viral causes of hepatitis were ruled out including levels for ANA, ASMA, AMA, Alpha-1-antitrypsin Ab and Ceruloplasmin. Viral infection was felt to be the most likely culprit for his hemolysis. He had an elevated LDH, decreased haptoglobin and peripheral smear showed atypical lymphocytes. Given his history of tea colored urine, CBC was ordered, showing anemia concern for hemolysis was high, and hemolytic panel was obtained. An abdominal ultrasound showed no ductal abnormalities. Repeat total bilirubin was elevated at 4.2 with direct bilirubin of 2.6. He did not have hepato-splenomegaly, but did have scleral icterus and was jaundiced. At our facility, physical examination was unremarkable for stigmata of chronic liver disease. He was consequently given intravenous fluid and pain medications and transferred to our facility for further work-up. CT abdomen and pelvis showed no evidence of pyelonephritis but did reveal hepatic steatosis and hepatic panel showed AST 127, ALT 170, ALP 97, and total bilirubin of 3.4. He denied any history of trauma, or heavy lifting. We describe the case of a 38-year-old male who presented with jaundice and flank pain, and was found to have deranged LFTs with fatty liver caused by EBV infection.Ī 38-year-old male with a history of GERD presented to an outside facility with three-days of nonradiating, bilateral flank pain associated with tea-colored urine. Infectious mononucleosis is a common cause of elevated LFT's, however icteric jaundice is rarely seen.
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