Acute pancreatitis as a complication of epstein-barr virus infection: A case report and narrative review

TL;DR

This paper reports a rare case of acute pancreatitis linked to Epstein-Barr virus (EBV) infection and reviews other similar cases to guide diagnosis and treatment.

Contribution

The study adds a new adult case and systematically reviews existing literature to highlight the under-recognized association between EBV and acute pancreatitis.

Findings

EBV-associated acute pancreatitis is rare and often lacks classic mononucleosis symptoms.

Conservative management is typically effective, with a generally favorable prognosis.

Coexisting risk factors may increase susceptibility to EBV-related pancreatic inflammation.

Abstract

Epstein–Barr virus (EBV) infection is common, but EBV-associated acute pancreatitis is rare and heterogeneous. We describe an adult case and synthesize published cases to inform diagnosis and management.

A 40-year-old man presented with sore throat and mild abdominal pain; examination showed a right peritonsillar abscess with uvular deviation. Laboratory testing revealed lipase 3704 U/L and elevated inflammatory markers; abdominal CT confirmed non-complicated acute pancreatitis. He received incision and drainage of the abscess plus conservative pancreatitis care. Symptoms resolved rapidly, lipase decreased to 352 U/L by day 2, and he was subsequently discharged. EBV serology later confirmed acute infection, and patient was asymptomatic at 2-month follow-up.

We searched PubMed to August 24, 2025, using (“Epstein-Barr virus” OR “EBV”) AND “pancreatitis,” including human case reports or series of EBV-associated acute pancreatitis. There were no language restrictions.

Of 60 records, 13 cases met criteria. Eight involved adults and most patients were female. Abdominal pain was common, but classic mononucleosis symptoms were infrequently reported. CT was the predominant diagnostic modality. Management was conservative in nearly all reports and antivirals were rarely used. Outcomes were generally favorable, with one fatal case.

EBV should be considered in unexplained acute pancreatitis, particularly when common etiologies are excluded or concurrent EBV features are present. Prognosis is typically good with supportive care, but coexisting risk factors may predispose patients to a more severe or complicated course. Transparent reporting of cofactors will clarify whether EBV acts as an opportunistic trigger or independent cause.

•EBV-associated acute pancreatitis is a rare but recognized complication in both pediatric and adult patients.•The clinical presentation is heterogeneous and may often lack typical features of infectious mononucleosis.•Conservative management is usually sufficient, and prognosis is favorable in most cases.•Coexisting risk factors may lower the threshold for EBV-related pancreatic inflammation.•Reporting of risk factors could clarify whether EBV acts as an opportunistic trigger or an independent cause of pancreatitis.

EBV-associated acute pancreatitis is a rare but recognized complication in both pediatric and adult patients.

The clinical presentation is heterogeneous and may often lack typical features of infectious mononucleosis.

Conservative management is usually sufficient, and prognosis is favorable in most cases.

Coexisting risk factors may lower the threshold for EBV-related pancreatic inflammation.

Reporting of risk factors could clarify whether EBV acts as an opportunistic trigger or an independent cause of pancreatitis.

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