Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Verywell / Michela Buttignol
Hepatitis in people with mononucleosis is often referred to as Epstein-Barr virus hepatitis, or simply EBV hepatitis.
Causes and Risk Factors of Mononucleosis
Hepatitis is theinflammationof the liver. It has many causes, both infectious (viral, bacterial, parasitic) and non-infectious (including alcoholism, metabolic dysfunction-associated steatotic liver disease, and certainautoimmune disorders).
Hepatitis can also be acute (inflammation begins suddenly and lasts for only a few weeks) or chronic (lasts more than six months and sometimes is permanent). Some acute infections can become chronic after the initial symptoms resolve, such as that seen in some people with hepatitis B and C.
Hepatitis is an uncommon presentation of mononucleosis but can occur when the EBV infection is especially severe. Theacute hepatitis symptomswill typically appear and resolve within the course of the EBV infection (usually two to four weeks) and tend to be milder than other forms of infectious hepatitis.
Symptoms commonly seen with EBV hepatitis include:
Jaundice, the yellowing of the skin and/or eyes, is a relatively rare feature of EBV hepatitis, although it has been known to occur.
Once the acute symptoms resolve, the liver function will typically return to normal with no long-term injury to the liver itself.
With that said, EBV hepatitis can become severe and even life-threatening in some people, particularlyimmunocompromisedpeople in whom the condition can lead toacute liver failure. This is an extremely rare complication, affecting less than 0.25% of people with mononucleosis, but is associated with a high mortality rate.
How Long Does Mono Fatigue Last?
EBV infection can often be asymptomatic (without symptoms) or subclinical (without notable symptoms), particularly in young children. Even so, the infection will almost invariably cause the elevation of liver enzymes known astransaminases.
Increases in transaminases often occur when there is a problem with the liver, during which the enzymes meant to break down toxins start to leach into the bloodstream. In most cases of mononucleosis, the elevation will be mild and transient, causing little if any liver-related symptoms.
However, on rare occasions when transaminase levels are five to 10 times higher than normal, EBV hepatitis can become symptomatic.EBV hepatitis typically occurs alongside characteristicsymptoms of mononucleosis, although it has been known to occur in isolation in some people.
Teens and younger adults are more likely to experience EBV hepatitis than children and older adults who tend to be asymptomatic or have flu-like symptoms.
Symptoms of mononucleosis can overlap those of EBV hepatitis and may include:
EBV hepatitis is especially concerning in people who have undergone aliver transplant. The infection may causeorgan rejectionor increase the risk ofpost-transplant lymphoproliferative disorders (PTLDs).
10 Complications of Hepatitis You Should Know
Whensymptoms of hepatitisdevelop, the doctor will typically perform a series of antibody tests known as a viral hepatitis panel that can detect the three most common causes of hepatitis, namely hepatitis A, B, and C.
With that said, infectious mononucleosis should be suspected in teens or young adults who also present with a sore throat, enlarged tonsils, or cervical lymphadenopathy. In fact, EBV should be explored in anyone with unexplained hepatitis symptoms, irrespective of age.
Healthcare professionals typically diagnose infectious mononucleosis based on symptoms. But blood tests and other procedures may be ordered if there are signs of hepatitis, in part to confirm that EBV is the cause and in part to rule out other potential causes.
Blood tests may include:
If the findings are ambiguous or the symptoms are severe or unusual, the doctor may order aliver biopsyin which a sample of liver tissue is obtained using a needle through the abdominal wall.
When examined under the microscope, the tissues will often show thick clusters of lymphocytes, typically in a single-file “string-of-pearl” pattern. That—and the lack of liver scarring (fibrosis)—can help differentiate EBV hepatitis from other forms of hepatitis.
To definitively diagnose EBV hepatitis, the doctor will exclude other possible explanations in theirdifferential diagnosis, including:
How Mononucleosis Is Diagnosed
The treatment of EBV hepatitis is generally supportive since most cases will resolve on their own after the infection runs its course. This typically involves rest, avoidance of contact sports, plenty of hydration, balanced nutrition, and over-the-counternonsteroidal anti-inflammatory drugs (NSAIDs)likeAdvil (ibuprofen)to relieve fever and body aches.
Tylenol (acetaminophen) is typically avoided due to the adverse impact it can have on the liver. The avoidance of alcohol is also key.
Antiviral Drugs for MononucleosisAntiviral drugslike Zovirax (acyclovir) have not proven to have any significant impact on EBV infection. Even so, some doctors have been known to use antivirals like Valcyte (valganciclovir) in combination withcorticosteroidsto treat severe EBV hepatitis in immunocompromised people.
Antiviral Drugs for Mononucleosis
Antiviral drugslike Zovirax (acyclovir) have not proven to have any significant impact on EBV infection. Even so, some doctors have been known to use antivirals like Valcyte (valganciclovir) in combination withcorticosteroidsto treat severe EBV hepatitis in immunocompromised people.
Despite their uncertain benefits, antivirals used to treat mononucleosis cause few side effects (mainly stomach ache, nausea, diarrhea, and headache). However, they can lead toantiviral resistanceif overused or not used appropriately.
Liver transplant recipients who develop acute EBV may require a change of treatment to help reduce viral activity and the risk of organ rejection. To this end, many doctors will temporarily stopimmunosuppressantslike Azasan (azathioprine) that leaves the body vulnerable to infection and increase corticosteroids like prednisolone that help reduce liver inflammation.
How Mononucleosis Is Treated
A Word From Verywell
Prevention is key to avoiding EBV hepatitis, particularly if you are immunocompromised or have recently undergone a liver transplant.
Because EBV is primarily transmitted through saliva, you would need to avoid sharing straws, food, utensils, cigarettes, inhalers, lipstick, or lip balm.Washing your handsand avoiding close contact with anyone who is sick (including kissing) is also essential.
As ubiquitous as EBV is, don’t assume that you have it and can ignore the simple guidelines. Taking a few reasonable precautions may not only spare you the rigors of symptomatic mono but can also protect you from othersaliva-borne infectionssuch asherpes simplex virus (HSV).
7 Autoimmune Diseases Linked to Epstein-Barr Virus
14 Sources
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