From the Research
The median AST and ALT levels in Epstein-Barr virus (EBV) infection are increased by an average maximum of 5-fold, with both transaminase levels starting to rise 2 days after the clinical onset of the disease and returning to normal after a period of 20 days 1. During acute EBV infection (infectious mononucleosis), liver enzyme elevations are common, occurring in approximately 80-90% of patients. These elevations usually develop within the first two weeks of illness and gradually normalize over 3-4 weeks as the infection resolves. The liver enzyme elevation pattern in EBV typically shows AST and ALT rising in parallel, with values rarely exceeding 10 times the upper limit of normal. This transient hepatitis is caused by the immune response to EBV-infected lymphocytes in the liver rather than direct viral infection of hepatocytes. While these enzyme elevations indicate liver involvement, they rarely progress to severe hepatitis or liver failure in immunocompetent individuals. No specific treatment is required for the hepatitis component of EBV infection beyond supportive care and monitoring of liver function until resolution. Some studies have reported rare cases of life-threatening jaundice and hepatic failure in patients with EBV infection, but these cases are extremely rare and often require a multidisciplinary approach for diagnosis and treatment 2. Other studies have investigated the use of steroids for symptom control in infectious mononucleosis, but the evidence is limited and inconclusive 3. Overall, the management of EBV infection should focus on supportive care and monitoring of liver function, with rare cases requiring more aggressive treatment. Key points to consider include:
- The median AST and ALT levels in EBV infection are increased by an average maximum of 5-fold 1
- Liver enzyme elevations are common in EBV infection, but rarely progress to severe hepatitis or liver failure 1
- The liver enzyme elevation pattern in EBV typically shows AST and ALT rising in parallel, with values rarely exceeding 10 times the upper limit of normal 1
- No specific treatment is required for the hepatitis component of EBV infection beyond supportive care and monitoring of liver function until resolution 1