Goetgebuer R L, van der Woude C J, de Ridder L, Doukas M, de Vries A C
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Department of Pediatric Gastroenterology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Int J Colorectal Dis. 2019 May;34(5):923-926. doi: 10.1007/s00384-019-03257-7. Epub 2019 Feb 9.
Epstein-Barr virus (EBV) is a proposed trigger in the etiopathogenesis of inflammatory bowel disease (IBD) and is associated with lymphoproliferative diseases. Nevertheless, testing for EBV DNA in the intestinal mucosa and screening for EBV infection before initiation of a drug therapy are not routinely performed. The aim of this article is to increase awareness of the relevance of EBV infection in specific clinical situations.
In this short communication, we describe the disease course of three IBD patients with EBV infection, varying from EBV reactivation during disease flare up to a trigger of EBV-related mucocutaneous ulcer (EBV-MCU) and haemophagocytic lymphohistiocytosis (HLH).
Our first patient was diagnosed with EBV reactivation-associated severe colitis and showed a rapid clinical improvement after induction therapy with infliximab and azathioprine. Without antiviral treatment, the patient remained in complete remission and no complications of EBV were seen. After diagnosing EBV-MCU in the second patient, immunosuppressive medication was discontinued and four infusions of rituximab resulted in a rapid clinical recovery and eventually complete response. After discontinuation of the immunosuppression in our last patient with haemophagocytic lymphohistiocytosis, treatment with a combination of corticosteroid and antiviral therapy resulted in a complete recovery over a time span of several weeks.
EBV infection has a wide variety of potentially life-threatening clinical manifestations in IBD patients. Testing for EBV in case of a flare up and screening for EBV before the start of immunosuppressive therapy will create awareness for EBV-related symptoms or complications during follow-up.
爱泼斯坦-巴尔病毒（EBV）被认为是炎症性肠病（IBD）发病机制中的一个触发因素，且与淋巴增殖性疾病有关。然而，在肠道黏膜中检测EBV DNA以及在开始药物治疗前筛查EBV感染并未常规进行。本文旨在提高对EBV感染在特定临床情况下相关性的认识。
在这篇简短的通讯中，我们描述了3例EBV感染的IBD患者的病程，从疾病发作时的EBV再激活到EBV相关的黏膜皮肤溃疡（EBV-MCU）和噬血细胞性淋巴组织细胞增生症（HLH）的触发。
我们的首例患者被诊断为与EBV再激活相关的重症结肠炎，在接受英夫利昔单抗和硫唑嘌呤诱导治疗后临床迅速改善。未经抗病毒治疗，该患者保持完全缓解，未出现EBV相关并发症。在第二例患者诊断出EBV-MCU后，停用免疫抑制药物，4次输注利妥昔单抗导致临床迅速恢复并最终完全缓解。在我们最后一例噬血细胞性淋巴组织细胞增生症患者停用免疫抑制后，联合使用皮质类固醇和抗病毒治疗在数周内实现了完全康复。
EBV感染在IBD患者中有多种潜在危及生命的临床表现。在疾病发作时检测EBV以及在开始免疫抑制治疗前筛查EBV，将提高对随访期间EBV相关症状或并发症的认识。
