Case Report: Severe cholestatic jaundice induced by Epstein-Barr virus infection in the elderly

Infectious mononucleosis due to Epstein-Barr virus (EBV) is almost always a self-limited disease, most commonly seen in young adults. Hepatitis is a well-recognized complication of EBV infection that usually resolves spontaneously. Jaundice occasionally results from the unusual complication of autoimmune haemolytic anaemia rather than hepatitis. We report a 60-year-old man with severe cholestatic jaundice whose history, liver histology and laboratory findings suggested EBV infection. He also developed significant jaundice related to his hepatitis, but not to autoimmune haemolysis, a situation that led to diagnostic delay. Costly diagnostic laboratory tests and invasive procedures were performed to rule out a malignant extrahepatic biliary obstruction. Physicians need to be aware of this complication and EBV infection should be included in the differential diagnosis of cholestatic jaundice in the elderly.     

Brief Report: Selected Aspects of Hodgkin's Disease in a Whole Community

All available hospital records of patients with Hodgkin’s Disease, diagnosedin Israel during a 5-year period were reviewed.

A bimodal incidence curve was obtained both for all patients, and for suchsubcategories as sex and ethnic origin. There was no significant differencein incidence between males and females, nor between various ethnic groups.

The frequency of patients presenting with a generalized disease at diagnosiswas relatively higher in males and in older patients of both sexes.

The median survival was 27 months with a considerably better prognosis inyounger patients of both sexes and in females younger than 45, as comparedto males of the same age group. Lymphocytopenic males had a shorter survivalcourse, but no such pattern was evident among females.

Submitted on December 5, 1968 Accepted on March 5, 1969     

An Epidemiological Study of Polycythemia Vera

An epidemiologic study based on all patients with polycythemia veraresiding at the Baltimore Metropolitan Area is reported. A minimum annualincidence rate of 4 new cases per million was observed for the MetropolitanArea and 5 per million per year for Baltimore City. The incidence rate waslower in negroes than in whites, but if age adjustment was applied the ratiowas more than 2:1. A marked increased frequency was noted among patients ofJewish origin. There was only a slight excess of males with a sex ratio 1.2:1.The age distribution confirmed the previous observations of only rare instancesof the disease below the age of 30; the mean and median ages were about 60years.

Submitted on August 8, 1964 Accepted on February 7, 1965