Muhammad B. Hammami, MD, Reem Aboushaar, MS, Ahmad Musmar, MD, Mishah Azhar, MD, Stephen M. Miller, MD, FACG, Peter Salomon, MD, FACG
Florida Atlantic University, Boca Raton, FL
Introduction: EBV infection is mostly subclinical and resolves spontaneously without complications. GI involvement manifests mainly with asymptomatic liver enzyme elevation. We report a case of acute pancreatitis complicating EBV infection.
Case Description/Methods: An 18 year old woman presented with 12 day history of moderate unremitting upper abdominal pain, nausea, and anorexia. She had a temperature of 36.8°C, bilateral non-tender cervical lymphadenopathy, mild pharyngeal injection, and moderate epigastric tenderness, but no splenomegaly or jaundice. She didn’t take any medications and denied alcohol/illicit drug use. Leukocyte count was 14.5 cells/μL (15% neutrophils, 9% monocytes, 44% reactive lymphocytes), hemoglobin 12.7 g/dL, amylase 327 IU/L, lipase 2016 U/L, alkaline phosphatase 246 IU/L, aspartate aminotransferase 210 IU/L, alanine aminotransferase 283 IU/L, total/direct bilirubin 2/1.6 mg/dL. Calcium, blood glucose, and triglycerides were normal. Ultrasound showed mildly enlarged liver with coarse echotexture, contracted gallbladder, normal common bile duct, and mildly enlarged right upper quadrant lymph nodes, but no intrahepatic biliary ductal dilation. Computed tomography showed acute pancreatitis and mild splenomegaly. Anti-HAV IgM; HBsAg and anti-HBV core IgM; anti-HCV; HIV1 p24 antigen; anti-HIV1 and anti-HIV2 antibodies (AB); and CMV (quantitative PCR) were negative. EBV heterophile AB was positive, EBV IgG viral capsid AB 78.6 U/mL, EBV IgM viral capsid AB >160 U/mL, and EBV IgG early disease AB 70 U/mL. She was treated conservatively and discharged on the fourth day of hospitalization.
Discussion: Clinical pancreatitis is rarely associated with EBV infection; only 17 cases have been previously reported. As in our case, most patients were adolescent/young adults, have clear EBV infection picture, and have mild to moderate pancreatitis course with spontaneous recovery. Although acyclovir was tried, it isn’t clear if it’s required. Our patient was unique in that her hospital stay was 4 days in comparison to a mean of 10 days in other reported cases. EBV infection should be considered in the differential diagnosis of mild to moderate pancreatitis. It is not clear if subclinical pancreatitis in the setting of EBV infection is more common and why only few patients develop clinical pancreatitis.
Citation: Muhammad B. Hammami, MD, Reem Aboushaar, MS, Ahmad Musmar, MD, Mishah Azhar, MD, Stephen M. Miller, MD, FACG, Peter Salomon, MD, FACG. P0070 - EPSTEIN BARR VIRUS (EBV)-ASSOCIATED ACUTE PANCREATITIS: CASE REPORT. Program No. P0070. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.