Coombs-Negative Haemolytic Anaemia, Direct Hyperbilirubinaemia and Splenomegaly: A Rare Amalgam
  • Radhika Kulkarni
    UCONN Health, Farmington, CT, USA
  • Amjad Basheer
    UCONN Health, Farmington, CT, USA
  • Aziz Khan
    UCONN Health, Farmington, CT, USA


Herpesvirus 4, direct Coombs test, cholestasis, splenomegaly


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.



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    Published: 2021-04-08
    Issue: 2021: Vol 8 No 4 (view)

    How to cite:
    Kulkarni R, Basheer A, Khan A. Coombs-Negative Haemolytic Anaemia, Direct Hyperbilirubinaemia and Splenomegaly: A Rare Amalgam. EJCRIM 2021;8 doi:10.12890/2021_002477.