傳染性單核球增多症併肝炎及腹水

Epstein-Barrvirus（EB病毒）所造成感染性單核球增多症，有3個典型的症狀，包括發燒、喉嚨痛及淋巴結腫大。其亦常會引起肝炎，在免疫正常的病人中，通常是會自行恢復。其急性期的表現是膽汁鬱積性的，所以會造成黃膽及輕中度的肝功能異常。若慢性持續發炎時，有時會造成肝衰竭。有報告指出其與肝細胞癌有關。此一21歲案例，其主訴是發燒、喉嚨痛及疲倦多日。理學檢查發現頸部有淋巴結腫大、扁桃腺腫大化膿、皮疹及肝脾腫大。實驗室檢查發現其肝功能指數異常，EB病毒抗原濃度上升，EB病毒抗體IgG及IgM都呈現陽性，A，B，C三型肝炎抗體皆陰性。腹部超音波檢查顯示有輕微腹水。此疾病會嚴重到產生腹水的情況不多，予以支持性治療3星期後，肝功能漸恢復正常。我們提出此病例報告，主要凸顯其對肝臟的影響，包括黃疸、肝臟轉化脢異常、肝門區發炎以及腹部超音波上的異常。

關鍵字

EB病毒；肝炎；肝功能異常

並列摘要

Epstein-Barr virus (EBV) often causes a triad of fever, sore throat, and lymphadenopathy, which is referred to as infectious mononucleosis. EBV hepatitis is an uncommon and almost self-limited disease in immunocompetent patients. Patients with acute EBV infections may develop cholestatic hepatitis with associated jaundice together with hepatitis with a moderate elevations in the level of transaminase. Splenic rupture, liver failure, autoimmune hepatitis and hepatocellular carcinoma may be associated with EBV due to acute and/or chronic EBV infection. We present the case of a 21-yearold man whose chief complaints were fever, sore throat and tiredness. The physical examination showed cervical lymphadenopathy, bilateral tonsils enlargement with a coating of exudate, maculopapular rush, splenomegaly and hepatomegaly. A laboratory analysis showed lymphocytosis, an elevation of the serum transaminase level together with the presence of bilirubin and GGT. An abdominal echo study revealed mild ascites. After 3 weeks of supportive treatment, liver function had returned to within the normal range. This article presents a case of EBV infection that shows clinically significant hepatitis and reviews the literature on the gastrointestinal complications associated with EBV.

並列關鍵字

Epstein Barr virus ； hepatitis ； liver dysfunction

國際替代計量

傳染性單核球增多症併肝炎及腹水

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