Background: Severe acute liver failure by Epstein-Barr virus is a rare event. A specific antiviral
treatment is not available and steroid use is controversial.
Objective: We report the beneficial effect of steroid therapy in this clinical condition.
Case Report: We observed the case of a 19-year male patient admitted to our Gastroenterology Unit for
an acute Epstein-Barr virus-related hepatitis (significant transaminase flare: aspartate transaminase x 91
and alanine transaminase x 56 the upper limit of normal, Model for End-stage Liver Disease: MELD
score 14). A severe liver injury occurred about 20 days after onset (MELD score 29). A prompt dramatic
improvement of liver damage markers was achieved after eight-day methylprednisolone intravenous
administration (MELD score 9) despite viral disappearance (i.e. absence of EBV-DNA in blood and nasopharyngeal
swab) occurred after 6 months. Anti-EBV IgM positivity was observed at the 14th month
despite presence of specific IgG (“past infection, IgM persisting”).
Conclusion: Therapeutic response suggests that the short-term use of steroids, even if not recommended
for routine treatment of infectious mononucleosis, may be effective to treat the immunemediated
symptoms. Possible steroid interactions with the host immune-response to the virus have not
been demonstrated in short-term administration. Our case suggests focusing on this last topic.