Infectious Mononucleosis and Transaminitis
Yes, infectious mononucleosis (mono) commonly causes transaminitis, with approximately 40-80% of children with infectious mononucleosis experiencing hepatic injury. 1
Pathophysiology and Prevalence
Infectious mononucleosis, primarily caused by Epstein-Barr virus (EBV), frequently affects the liver, resulting in:
- Transaminitis (elevated liver enzymes) in 40-80% of pediatric cases 1
- Hepatomegaly in approximately 10% of patients 2
- Clinical jaundice in rare cases 3
The liver involvement in EBV infection typically manifests as:
- Elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
- A study found that 57.4% of infectious mononucleosis patients had both elevated transaminases and atypical lymphocytes 4
Clinical Presentation of Liver Involvement
When evaluating a patient with suspected mono, be alert for signs of liver involvement:
- Right upper quadrant tenderness
- Hepatomegaly (present in 31-49% of cases with hepatic injury) 1
- Jaundice (uncommon but possible)
- Laboratory findings showing elevated transaminases (ALT > 40 U/L typically defines hepatic injury in mono) 1
Risk Factors for Hepatic Injury in Mono
Several factors increase the likelihood of liver involvement:
- Age (older children/young adults have higher risk) 1
- Female gender 1
- Presence of splenomegaly (81% of hepatic injury cases vs. 58% in those without) 1
- Immunosuppression (higher risk for severe complications) 2
Management Considerations
For patients with mono-associated transaminitis:
- The condition is typically self-limiting and resolves with supportive care
- Monitor liver function tests but specific hepatic-directed therapy is usually unnecessary
- Be vigilant for rare complications like acute acalculous cholecystitis 5, 3
- Avoid hepatotoxic medications when possible
Potential Complications
While rare, be aware of potential hepatic complications:
- Severe hepatitis
- Acute acalculous cholecystitis 5, 3
- Very rarely, hepatic failure (one of the main causes of death in fatal infectious mononucleosis) 1
Clinical Pearls
- Transaminitis without clinical jaundice is common in mono
- The pattern of liver enzyme elevation may help differentiate mono from other causes of hepatitis
- Combined detection of atypical lymphocytes and elevated transaminases can be a useful diagnostic marker for infectious mononucleosis 4
- Liver involvement in mono is typically transient and resolves without specific treatment
Remember that while transaminitis is common in mono, it rarely progresses to severe liver disease in immunocompetent patients, and supportive care remains the mainstay of treatment.