Duncan Ashten, Veli Ivonne, Tsosie Dathan, Koffler Elizabeth
Medicos de El Centro Family Medicine Residency Program, Espanola, NM, USA.
University of New Mexico-Santa Fe Family Medicine Residency Program, Santa Fe, NM, USA.
J Med Case Rep. 2024 Dec 23;18(1):605. doi: 10.1186/s13256-024-04969-3.
Recent biomedical research has shown the unusual, multisystem effects of coronavirus disease 2019 in humans. One specific sequela of a primary severe acute respiratory syndrome coronavirus 2 infection is the reactivation of latent viruses in various tissues, such as Epstein-Barr virus. Epstein-Barr virus has been identified in many inflammatory gastrointestinal lesions, such as microscopic gastritides and colitides. One subtype of these diseases is collagenous disease. "Long COVID" may be related to the reactivation of these latent viruses, and the following case describes a patient who developed vague symptoms consistent with "long COVID."
A non-Hispanic white male in his 50s, with previous collagenous gastritis and colitis, developed a 10-kg weight loss and diffuse leg cramps over 3 months. The patient had coronavirus disease 2019 about 3 months prior to presentation. He had iron deficiency and tested positive for human immunodeficiency virus antibody. His heterophile antibody was also positive. Confirmatory testing for human immunodeficiency virus was negative, and his Epstein-Barr virus antibody panel was positive for early antigen immunoglobulin G. His Epstein-Barr virus viral load was undetectable. Minimal improvement was achieved with a 4-week course of oral budesonide, and upper endoscopy showed diffuse gastritis. He is now improving with proton pump inhibitor therapy and ferrous sulfate supplementation.
This case report explores outpatient management of microscopic gastritides and colitides. The evidence around coronavirus disease 2019 causing reactivation of Epstein-Barr virus, and Epstein-Barr virus' presence in chronic gastrointestinal inflammatory lesions, is discussed. Practice recommendations include corticosteroid and acid-suppression therapy for patients suspected of having a recurrence of inflammatory lesions.
近期生物医学研究显示了2019冠状病毒病对人类不同寻常的多系统影响。严重急性呼吸综合征冠状病毒2原发性感染的一个特定后遗症是各种组织中潜伏病毒的重新激活，如爱泼斯坦-巴尔病毒。在许多炎症性胃肠道病变中已发现爱泼斯坦-巴尔病毒，如显微镜下胃炎和结肠炎。这些疾病的一个亚型是胶原性疾病。“长新冠”可能与这些潜伏病毒的重新激活有关，以下病例描述了一名出现与“长新冠”相符的模糊症状的患者。
一名50多岁的非西班牙裔白人男性，既往有胶原性胃炎和结肠炎，在3个月内体重减轻了10公斤，并出现弥漫性腿部痉挛。该患者在就诊前约3个月感染了2019冠状病毒病。他患有缺铁性贫血，人类免疫缺陷病毒抗体检测呈阳性。他的嗜异性抗体也呈阳性。人类免疫缺陷病毒的确诊检测为阴性，他的爱泼斯坦-巴尔病毒抗体检测显示早期抗原免疫球蛋白G呈阳性。他的爱泼斯坦-巴尔病毒病毒载量检测不到。口服布地奈德4周疗程仅取得了轻微改善，上消化道内镜检查显示弥漫性胃炎。他目前在接受质子泵抑制剂治疗和补充硫酸亚铁后病情正在好转。
本病例报告探讨了显微镜下胃炎和结肠炎的门诊管理。讨论了关于2019冠状病毒病导致爱泼斯坦-巴尔病毒重新激活以及爱泼斯坦-巴尔病毒在慢性胃肠道炎症性病变中存在的证据。实践建议包括对疑似炎症性病变复发的患者进行皮质类固醇和抑酸治疗。
