# Adolescent Epstein–Barr virus–associated cholestatic jaundice with porta hepatis/pancreatic head lymphadenopathy and transient CA 19-9 elevation: a case report

## TL;DR

A 15-year-old girl with Epstein-Barr virus (EBV) developed jaundice and elevated CA 19-9, mimicking biliary obstruction, but improved with conservative care and no invasive procedures.

## Contribution

Highlights EBV-related cholestatic hepatitis in adolescents with transient CA 19-9 elevation and lymphadenopathy mimicking malignancy.

## Key findings

- EBV-related cholestatic hepatitis in adolescents can present with transient CA 19-9 elevation and reactive lymphadenopathy.
- Conservative management and serial assessments can avoid unnecessary invasive procedures in EBV-related cases.
- MRCP is effective in excluding biliary obstruction in such cases.

## Abstract

Cholestatic jaundice is uncommon in adolescents. Epstein–Barr virus (EBV)–related inflammatory lymphadenopathy can mimic malignant biliary obstruction and cause a transient rise in carbohydrate antigen 19-9 (CA 19-9), complicating diagnosis.

A previously healthy 15-year-old girl presented with 6 days of jaundice and dark urine without fever. Physical examination showed moderate generalized jaundice with mild scleral icterus; multiple mobile, non-tender lymph nodes in the bilateral cervical regions and right post-auricular area (largest ∼2 × 2 cm); palpable liver and spleen; and mild right upper-quadrant tenderness with equivocal Murphy's sign. Initial tests showed a cholestatic pattern (total/direct bilirubin 102.4/67.7 μmol/L at the referring hospital; and 133.2/126.3 μmol/L on admission) with elevated ALP/GGT and total bile acids. CT suggested a porta hepatis-to-pancreatic-head soft-tissue density with mild intrahepatic ductal prominence; CA 19-9 was 117.7 U/mL [ref <37 U/mL]. EBV POCT was positive; EBV DNA was detected at low level. MRI/MRCP (2025-09-29) showed no obvious biliary obstruction. After MRCP excluded fixed biliary obstruction, the patient improved with conservative management (diagnostic evaluation, close monitoring, and symptom-directed care) without invasive intervention; CA 19-9 declined. No causal inference regarding any medication effect should be drawn, and we do not recommend self-medication or routine off-label/unlicensed use of cholestasis-directed agents for EBV infection. In immunocompetent hosts, EBV-related lymphadenopathy is usually self-limited, and this case does not represent EBV-associated lymphoproliferative disease.

EBV-related cholestatic hepatitis in adolescents can present with transient CA 19-9 elevation and reactive porta hepatis/pancreatic head lymphadenopathy, mimicking malignant obstruction. Serial laboratory and imaging assessments—particularly MRCP—together with conservative management may obviate unnecessary invasive procedures.