Makino Yuichi, Tani Chikayoshi, Miyokawa Naoyuki, Yoshimoto Ryota, Mizumoto Katsutoshi, Eguchi Kohei, Fujishiro Daisuke, Kodama Satoru, Kobayashi Atsushi, Komura Keiji, Okamoto Kensaku, Furukawa Hiroyuki, Haneda Masakazu
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan.
Intern Med. 2015;54(22):2851-5. doi: 10.2169/internalmedicine.54.4735. Epub 2015 Nov 15.
A 47-year-old woman with a 2-year history of rheumatoid arthritis (RA) undergoing methotrexate treatment developed a perforated ulcer in the ileum for which she underwent emergency surgery. A histological analysis of the extirpated specimen presented a possible Epstein-Barr virus (EBV) infection in the ulcerative lesion without a feature of lymphoproliferative disorder. Interestingly, the patient's serological tests with a paired serum diagnosed a primary EBV infection. The present case emphasizes the importance of being aware of severe enteritis as a possibility for patients with RA, for an accurate diagnosis.
一名47岁患类风湿关节炎（RA）2年且正在接受甲氨蝶呤治疗的女性，发生了回肠穿孔性溃疡，并因此接受了急诊手术。对切除标本进行的组织学分析显示，溃疡性病变中可能存在爱泼斯坦-巴尔病毒（EBV）感染，但无淋巴增殖性疾病特征。有趣的是，该患者的双份血清血清学检测诊断为原发性EBV感染。本病例强调了对于RA患者，认识到严重肠炎作为一种可能性对于准确诊断的重要性。
