Severe Transaminitis in SARS-CoV-2 and EBV Coinfection: A Case Report

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Epstein-Barr Virus (EBV) are each individually associated with mild hepatic injury and, rarely, with hyperbilirubinemia. SARS-CoV-2 and EBV coinfection is not well documented, but mild hepatic injury has been demonstrated. This case highlights a rare case of severe transaminitis and hyperbilirubinemia from SARS-CoV-2 and EBV coinfection. Case presentation: A 25-year-old man, with no significant past medical history, acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Epstein-Barr virus (EBV) coinfection and developed severe transaminitis, moderate hyperbilirubinemia, and hepatosplenomegaly. The patient’s transaminitis returned to baseline over the course of weeks with no long-term sequelae. Conclusions: While SARS-CoV-2 and EBV are each independently associated with mild hepatic injury, this case highlights a rare presentation of severe liver injury, possibly due to synergistic viral effects.