Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2022; 10(23): 8242-8248
Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8242
Epstein–Barr-virus-associated hepatitis with aplastic anemia: A case report
Wan-Jun Zhang, Li-Qiang Wu, Jun Wang, Sheng-Yun Lin, Bo Wang
Wan-Jun Zhang, Li-Qiang Wu, Jun Wang, Sheng-Yun Lin, Bo Wang, Department of Hematology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Author contributions: Zhang WJ collected, analyzed the data and wrote the manuscript; Wu LQ, Wang J, Lin SY and Wang B made the treatment plan of the patient and participated in the whole process of patient treatment; and all authors have read and approve the final manuscript.
Informed consent statement: Before treatment, patients and their families have signed informed consent for treatment.
Conflict-of-interest statement: There is no conflict of interest among all authors.
CARE Checklist (2016) statement: This manuscript was checked according to the checklist (2016) statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Bo Wang, MM, Attending Doctor, Department of Hematology, The First Affiliated Hospital, Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 310006, China.
Received: December 28, 2021
Peer-review started: December 28, 2021
First decision: April 8, 2022
Revised: April 19, 2022
Accepted: June 27, 2022
Article in press: June 27, 2022
Published online: August 16, 2022



Hepatitis-associated aplastic anemia (HAAA) is a rare condition. Patients with HAAA usually present with acute hepatitis, jaundice and significantly increased transaminase. After 1–2 mo, hepatitis gradually improves, but progressive hemocytopenia, bone marrow hematopoietic failure, and severe or extremely severe aplastic anemia are manifest. Most cases of HAAA are fulminant and usually lethal if left untreated. The literature on Epstein–Barr virus (EBV)-associated HAAA is sparse.


We report a 30-year-old man who was admitted to our hospital because of pale yellow urine and skin with a simultaneous decrease in peripheral blood ternary cells. We made a diagnosis of EBV-associated HAAA. The treatment strategy for this patient included eltrombopag, an immunosuppressive regimen of rabbit anti-human thymocyte immunoglobulin, cyclosporine, and supportive care. The patient was discharged in normal physical condition after five months. A hemogram performed on follow-up revealed that he had achieved a complete response.


Eltrombopag plus anti-thymocyte globubin and cyclosporine may be a therapeutic option for EBV-associated HAAA.Larger studies are warranted to confirm.

Keywords: Epstein–Barr virus, Hepatitis-associated aplastic anemia, Immunosuppressive therapy, Eltrombopag, Case report

Core tip: We found an unexpected association between Epstein–Barr virus (EBV) and hepatitis-associated aplastic anemia (HAAA). Reports on EBV-associated HAAA are sparse. HAAA is a type of severe AA, and the treatment strategy pursued was in accordance with the 2016 British guidelines for AA. The patient achieved a complete response after immunosuppressive therapy. This current study highlights the importance of early diagnosis and timely therapy for EBV-associated HAAA.