Epstein-Barr Virus-Related Hyperacute Hepatitis: May Intravenous Steroids be an Effective Approach?

Background: Severe acute liver failure by Epstein-Barr virus is a rare event. A specific antiviral treatment is not available and steroid use is controversial. Objective: We report the beneficial effect of steroid therapy in this clinical condition. Case Report: We observed the case of a 19-year male patient admitted to our Gastroenterology Unit for an acute Epstein-Barr virus-related hepatitis (significant transaminase flare: aspartate transaminase x 91 and alanine transaminase x 56 the upper limit of normal, Model for End-stage Liver Disease: MELD score 14). A severe liver injury occurred about 20 days after onset (MELD score 29). A prompt dramatic improvement of liver damage markers was achieved after eight-day methylprednisolone intravenous administration (MELD score 9) despite viral disappearance (i.e. absence of EBV-DNA in blood and nasopharyngeal swab) occurred after 6 months. Anti-EBV IgM positivity was observed at the 14th month despite presence of specific IgG (“past infection, IgM persisting”). Conclusion: Therapeutic response suggests that the short-term use of steroids, even if not recommended for routine treatment of infectious mononucleosis, may be effective to treat the immunemediated symptoms. Possible steroid interactions with the host immune-response to the virus have not been demonstrated in short-term administration. Our case suggests focusing on this last topic.