Coombs-Negative Haemolytic Anaemia, Direct Hyperbilirubinaemia and Splenomegaly: A Rare Amalgam.

INTRODUCTION: Epstein-Barr virus (EBV) is notorious for its varied presentation in adults. Reactivation of EBV can occur at any time and is often due to weakened cellular immunity. CASE DESCRIPTION: Here we report the case of a young woman with no previous medical history who presented with cholestatic hepatitis, Coombs-negative haemolytic anaemia and splenomegaly. Due to the initial disjointed picture with no other localizing symptoms, she underwent extensive work-up for the same. DISCUSSION: EBV has been associated with many malignancies, autoimmune diseases and chronic fatigue syndrome. EBV causes elevated liver enzymes; however, cholestatic hepatitis is exceedingly rare, with only a few cases reported. Haemolytic anaemia is a common complication of EBV infection and is often Coombs positive.
CONCLUSION: EBV testing should be considered before more invasive and expensive work-up in a patient presenting with multi-systemic abnormalities. LEARNING POINTS: Epstein-Barr virus (EBV) can have myriad manifestations in all age groups.Coombs-negative haemolytic anaemia can occur as a complication of EBV.EBV testing should be considered prior to more expensive work-up in anyone presenting with abnormalities in the reticuloendothelial system. © EFIM 2021.