Losco Alessandra, Gianelli Umberto, Cassani Barbara, Baldini Luca, Conte Dario, Basilisco Guido
Postgraduate School of Gastroenterology, University of Milan, IRCCS - Ospedale Maggiore and Ospedale S Paolo, Milan, Italy.
Inflamm Bowel Dis. 2004 Jul;10(4):425-9. doi: 10.1097/00054725-200407000-00015.
Although no increased risk of developing lymphoproliferative disorders has been observed in population-based studies of patients with Crohn's disease, the possibility has been suggested in the subset of patients previously treated with thiopurine metabolites and suffering from concomitant Epstein-Barr virus infection. A few cases of lymphomas have occurred in patients with Crohn's disease treated with infliximab, only one of whom showed the presence of the Epstein-Barr virus genome. We here describe the case of a patient with steroid-dependent ileal Crohn's disease treated with azathioprine and a single infusion of infliximab, who developed a diffuse large B cell ileal lymphoma. Epstein-Barr virus genome was detected in the neoplastic cells by means of polymerase chain reaction. Epstein-Barr virus may be detected in the neoplastic tissues of lymphomas of patients with Crohn's disease treated with immunosuppressants and infliximab. The identification of such cases may help to define the frequency of this association and how to manage the lymphoproliferative disorder.
尽管在基于人群的克罗恩病患者研究中未观察到发生淋巴增生性疾病的风险增加，但在先前接受硫嘌呤代谢物治疗且伴有爱泼斯坦-巴尔病毒感染的患者亚组中已有人提出存在这种可能性。在用英夫利昔单抗治疗的克罗恩病患者中发生了几例淋巴瘤，其中只有1例显示有爱泼斯坦-巴尔病毒基因组。我们在此描述1例依赖类固醇的回肠克罗恩病患者，该患者接受了硫唑嘌呤治疗并单次输注英夫利昔单抗，之后发生了弥漫性大B细胞回肠淋巴瘤。通过聚合酶链反应在肿瘤细胞中检测到了爱泼斯坦-巴尔病毒基因组。在用免疫抑制剂和英夫利昔单抗治疗的克罗恩病患者的淋巴瘤肿瘤组织中可能检测到爱泼斯坦-巴尔病毒。识别此类病例可能有助于确定这种关联的频率以及如何处理淋巴增生性疾病。
