Abstract: Objective To Study the liver pathology and clinical features of patients with Epstein-Barr virus (EBV) infection, and provide ideas for diagnosis and treatment of EBV hepatitis.Methods Patients' information were collected from July 2015 to July 2020 in the Second Affiliated Hospital of Kunming Medical University. These patients all underwent liver biopsy, in situ hybridization staining of EBV-encoded RNA (EBER) and EBV DNA serology. According to the EBV DNA results, the patients were divided into EBV infection group and non-infected group. There were 15 patients in the EBV infection group and 41 patients in the non-infected group. The reasons for visits, discharge diagnosis, histopathological characteristics and EBER results of patients with EBV infection were analyzed, and the basic information and laboratory indicators of two groups were compared.Results Patients in the infection group came to our hospital with different symptoms or only abnormal liver enzymes. In addition to EBV infection, 9 people had other liver diseases at the time of discharge, and 3 of them had autoimmune liver diseases (all of which were newly diagnosed). Among all the patients undergoing EBER examination, only one patient in the infection group was EBER positive, and the other were negative. The EBER-positive patient didn't have characteristic microscopic findings related to EBV hepatitis including a diffuse lymphocytic sinusoidal infiltrate in a “string of beads” pattern. There were significant differences in age (P=0.012) and globulin (P=0.032) between the EBV infection group and the non-infected group.Conclusion The clinical manifestations of EBV infection are not specific, the possibility of EBV infection should be considered especially when patients with liver injury. Although there are many patients with EBV infection, EBV hepatitis is rare, and the pathological features may not be characteristic. When patients with EBV infection have fever, hepatosplenomegaly and so on, the EBER is an important auxiliary method for diagnosing EBV hepatitis. EBV infection with autoimmune liver disease is not rare, and EBV may play an important role in the occurrence and development of autoimmune liver disease. Further research is still needed to determine whether EBV is just an innocent bystander or a real pathogen.

Key words: Epstein-Barr virus infection, Liver injury, Pathology, EBER, Autoimmune liver disease