CASE REPORT article
Front. Pediatr.
Sec. Pediatric Gastroenterology, Hepatology and Nutrition
This article is part of the Research TopicCase Reports in Pediatric Gastroenterology, Hepatology, and Nutrition 2025View all 9 articles
Adolescent Epstein–Barr Virus–Associated Cholestatic Jaundice with Porta Hepatis/Pancreatic Head Lymphadenopathy and Transient CA 19-9 Elevation: A Case Report
Provisionally accepted
- 1Yibin Hospital Affiliated to Children'sHospital of Chongqing Medical University, Yibin, China
- 2Children's Hospital of Chongqing Medical University, Chongqing, China
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Background: 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 [1–3, 6, 12]. Case presentation: 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. Conclusion: 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 [4, 5, 12].
Keywords: Adolescent, CA 19-9, Cholestatic jaundice, Epstein–Barr virus, Infectious Mononucleosis, lymphadenopathy, MRCP
Received: 04 Dec 2025; Accepted: 12 Feb 2026.
Copyright: © 2026 Chen, Liu and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ying Chen
Bo Liu
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