Gali Vasantha, Bleeker Jonathan S, Lynch Douglas
Baylor College of Medicine.
Division of Hematology/Oncology, University of South Dakota Sanford School of Medicine.
S D Med. 2018 Jun;71(6):252-255.
Epstein-Barr virus (EBV) is known to be associated with B-cell lymphoproliferative disorders, and EBV-positive mucocutaneous ulcer (EBV-MCU) is a recently described entity observed in immunocompromised individuals. EBV-MCU is an aggressive appearing ulcerated lesion seen in the skin, oral cavity, and gastrointestinal tract. The process has Hodgkin-like features with a self-limited, indolent course, generally responding well to conservative management. We present a case of EBV-MCU recently encountered in a 54-year-old renal transplant recipient. She had persistent rectal pain and bleeding for over a year following hemorroidectomy. A large ulcer in the distal rectum with excoriation and granular margins was noted on examination, and an initial biopsy from the lesion was inconclusive. A repeat biopsy demonstrated ulcerated squamous and colonic mucosa with a polymorphic lymphoid infiltrate in the submucosa that contained large atypical cells. The large atypical cells were positive for PAX-5 and CD30 and demonstrated EBV RNA by in situ hybridization. EBV-MCU is a recently described occurrence in transplant patients, and awareness of this recently described entity is necessary for appropriate diagnosis and treatment.
已知爱泼斯坦-巴尔病毒（EBV）与B细胞淋巴增殖性疾病有关，EBV阳性黏膜皮肤溃疡（EBV-MCU）是最近在免疫功能低下个体中发现的一种疾病。EBV-MCU是一种在皮肤、口腔和胃肠道出现的具有侵袭性的溃疡性病变。该病变具有霍奇金样特征，病程自限、进展缓慢，通常对保守治疗反应良好。我们报告一例54岁肾移植受者近期发生的EBV-MCU病例。她在痔切除术后持续出现直肠疼痛和出血超过一年。检查发现直肠远端有一个大溃疡，边缘有擦伤和颗粒状，病变的初次活检结果不明确。再次活检显示溃疡的鳞状和结肠黏膜，黏膜下层有多形性淋巴细胞浸润，其中包含大的非典型细胞。大的非典型细胞PAX-5和CD30呈阳性，原位杂交显示EBV RNA阳性。EBV-MCU是移植患者中最近发现的一种疾病，认识到这种新发现的疾病对于正确的诊断和治疗很有必要。
