A case of concomitant epstein-barr virus-induced hepatitis on chronic autoimmune hepatitis

Autoimmune hepatitis (AIH), a rare cause of chronic liver disease in Korea, is a chronic, predominantly periportal hepatitis characterized by hypergammaglobulinemia, tissue autoantibodies, and responsiveness to immunosuppressive therapy. Here we report a rare case of Epstein-Barr virus (EBV) hepatitis in the presence of a previous diagnosis of AIH. A 25-year-old woman was admitted to the hospital with fever and myalgias. Laboratory data showed elevated aminotransferases, hypergammaglobulinemia, increased anti-nuclear antibody (ANA) titer, positive anti-smooth muscle antibody (ASMA) test, negative anti-mitochondrial antibody (AMA) test, and negative antibody against liver kidney microsome-1 (anti-LKM-1) test. Serologic viral markers of EBV indicated a recent EBV infection. Liver biopsy was performed to search for evidence of accompanying autoimmune liver disease. Liver biopsy findings were consistent with chronic active hepatitis. In-situ hybridization performed on the liver tissue confirmed the presence of EBV DNA. The patient has been treated with prednisolone and has shown subsequent improvement in clinical symptoms and liver function tests. (Korean J Med 74:658-662, 2008)