Abstract
BACKGROUND: Epstein-Barr virus (EBV) infection is common, but EBV-associated acute pancreatitis is rare and heterogeneous. We describe an adult case and synthesize published cases to inform diagnosis and management. CASE PRESENTATION: A 40-year-old man presented with sore throat and mild abdominal pain; examination showed a right peritonsillar abscess with uvular deviation. Laboratory testing revealed lipase 3704 U/L and elevated inflammatory markers; abdominal CT confirmed non-complicated acute pancreatitis. He received incision and drainage of the abscess plus conservative pancreatitis care. Symptoms resolved rapidly, lipase decreased to 352 U/L by day 2, and he was subsequently discharged. EBV serology later confirmed acute infection, and patient was asymptomatic at 2-month follow-up. METHODS: We searched PubMed to August 24, 2025, using ("Epstein-Barr virus" OR "EBV") AND "pancreatitis," including human case reports or series of EBV-associated acute pancreatitis. There were no language restrictions. RESULTS: Of 60 records, 13 cases met criteria. Eight involved adults and most patients were female. Abdominal pain was common, but classic mononucleosis symptoms were infrequently reported. CT was the predominant diagnostic modality. Management was conservative in nearly all reports and antivirals were rarely used. Outcomes were generally favorable, with one fatal case. CONCLUSIONS: EBV should be considered in unexplained acute pancreatitis, particularly when common etiologies are excluded or concurrent EBV features are present. Prognosis is typically good with supportive care, but coexisting risk factors may predispose patients to a more severe or complicated course. Transparent reporting of cofactors will clarify whether EBV acts as an opportunistic trigger or independent cause.