A Case Report Of Infectious Mononucleosis Complicated With Liver Damage And Literatures Analysis

Objectives:Infectious mononucleosis(IM)is a disease caused by acute infection of pathogens such as EB virus(Epstein-Barr virus,EBV),with different symptoms and complications that can affect multiple systems of the whole body.Clinicians do not know enough about this disease,which easily leads to misdiagnosis and missed diagnosis.This article reports a case of Infectious mononucleosis complicated with liver damage recently diagnosed in the First Affiliated Hospital of Guangxi Medical University,and comprehensively discusses the epidemiology,symptom characteristics,laboratory examination,disease diagnosis,treatment and prognosis of the disease in combination with relevant literature,so as to improve the understanding of the disease.Method:The clinical symptoms,auxiliary examinations,diagnostic characteristics,treatment and prognosis of a patient with IM complicated with liver damage admitted to the First Affiliated Hospital of Guangxi Medical University on January 26,2019 were retrospectively analyzed,and the diagnosis and treatment characteristics of this type of patient were summarized by reviewing the domestic and foreign literatures.Result:The 19-year-old male patient suffered from strong tea-like urine,fatigue,weakness,nausea,anorexia,greasy feeling,waist and back swelling and other discomfort after overwork on January 19,2019.He took 2 packs of"999Ganmaoling"on his own without obvious improvement.1 day before went to the hospital for treatment the liver function check showed:total bilirubin66.2?mol/L,direct bilirubin 40.5?mol/L,indirect bilirubin 25.7?mol/L,glutamyl transpeptidase(GGT)234U/L,alanine aminotransferase(ALT)947U/L,aspartate aminotransferase(AST)374 U/L.Blood routine:white blood cell count 22.9×10~9/L,lymphocyte percentage 0.828,absolute value of lymphocyte 18.9×10~9/L.Abdominal ultrasound shows:Spleen was large.No special treatment was given and the symptoms were not relieved.Due to"yellow urine and fatigue for 1week",he went to The First Affiliated Hospital of Guangxi Medical University and was hospitalized.He is normally healthy,has no special medical history,occasionally drinks a small amount of alcohol,and has no special personal history.The physical examination showed normal vital signs,slight yellow sclera stain,no palpable swelling of lymph nodes,no tenderness of sternum,slightly red pharynx,small bilateral tonsils,and no obvious abnormality in other physical examinations.Complete related examinations on admission,blood routine:white blood cell count 18.91×10~9/L,lymphocyte percentage 0.707,absolute value of lymphocyte 13.37×10~9/L.Liver function:total bilirubin56.40?mol/L,direct bilirubin 32.50?mol/L,indirect bilirubin 23.90?mol/L,glutamyl transpeptidase(GGT)235U/L,alanine aminotransferase(ALT)554U/L,aspartate aminotransferase(AST)227 U/L.EB virus shell antigen antibody(EBVCAIgA)is positive,EB virus nuclear antigen 1(EBNA1IgA)is negative.EB virus DNA(EBV-PCR)was qualitatively positive and quantitatively 3.75×10~3copies/ml.Peripheral blood leukocyte count:50%of heterotypic lymphocytes.Abdominal ultrasound and CT showed hepatomegaly and spleno-megaly.The diagnosis is:1.infectious mononucleosis;2.EB virus liver damage.During hospitalization,the patient was given symptomatic and supportive treatment such as liver protection and jaundice reduction.The symptoms of the patient gradually improved,and the relevant indicators showed a trend of improvement after repeated reviews.The patient was discharged on February 9,2019.From March 1 to the outpatient department for reexamination,there was no discomfort and the general situation was good.The indexes of blood routine,liver function,peripheral blood leukocyte classification count,EBV related examination and so on were normal.Conclusion:1.Young IM patients may have atypical clinical symptoms and may complain of liver damage and other related complications.2.Peripheral blood lymphocytes or abnormal lymphocytes are high.IM should be suspected and EBV related examination should be improved.3.IM complicated with liver damage is usually self-limiting and has a good prognosis.Generally,antiviral or hormone therapy is not required.