Epstein-Barr virus (EBV) infection is common in children and usually presents as infectious mononucleosis with fever, sore throat and lymphadenopathy. Although mild liver involvement is frequently seen, cholestatic jaundice is rare in paediatric patients. Marked hyperferritinaemia is also uncommon and may raise concern for serious inflammatory, hepatic or haematological disease. We describe a child who presented with fever, jaundice, dark urine and abdominal pain. Blood tests showed cholestatic hepatitis with significantly elevated liver enzymes and ferritin levels. Further investigations excluded hepatitis A-E, autoimmune liver disease, metabolic causes and haemophagocytic lymphohistiocytosis. EBV serology confirmed acute primary infection. The patient was managed conservatively with supportive care and showed gradual clinical and biochemical improvement without complications. This case highlights the importance of considering EBV infection in children presenting with cholestatic jaundice and hyperferritinaemia, particularly when the initial presentation suggests more severe liver or systemic inflammatory disease.

Keywords: Epstein-Barr Virus (EBV); Cholestatic Jaundice; Hyperferritinaemia; Haemophagocytic Lymphohistiocytosis (HLH)

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