Liang Mei, Qu Junyan
Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China.
BMC Infect Dis. 2025 Jan 9;25(1):50. doi: 10.1186/s12879-024-10422-z.
Chronic active Epstein-Barr virus (CAEBV) colitis is a rare disease with clinical and endoscopic manifestations very similar to those of inflammatory bowel disease (IBD). In clinical practice, it is easy to be misdiagnosed and mistreated, leading to poor clinical outcomes.
We report a case of a 56-year-old Chinese woman who presented with 6 years of intermittent severe diarrhea, fever, and abdominal pain. Ulcerative colitis was initially suspected. The patient's clinical symptoms were partially relieved after treatment with mesalazine and probiotics. However, the symptoms were repeated and improved after supportive and symptomatic treatment each time. Colonoscopy revealed multiple mucosal erosion and edema in the colon, EBV-encoded small RNA 1/2 in situ hybridization in the pathological tissue of the colon was positive (20/HP), and EBVDNA in the peripheral blood was positive. CAEBV colitis was diagnosed. The patient was given dexamethasone and acyclovir, and she was improved after treatment. Unfortunately, she was discharged without outpatient follow-up, and similar symptoms recurred one year later, with similar colonoscopy and pathological examinations. Symptoms were relieved after dexamethasone treatment.
This case highlights the diagnostic challenges posed by nonspecific clinical manifestations of CAEBV colitis, which should be included as a differential diagnosis in patients with recurrent diarrhea and fever to avoid misdiagnosis.
慢性活动性EB病毒（CAEBV）结肠炎是一种罕见疾病，其临床和内镜表现与炎症性肠病（IBD）非常相似。在临床实践中，该病容易被误诊和误治，导致临床预后不佳。
我们报告一例56岁中国女性患者，她有6年间歇性严重腹泻、发热和腹痛症状。最初怀疑为溃疡性结肠炎。患者接受美沙拉嗪和益生菌治疗后临床症状部分缓解。然而，症状反复出现，每次经支持和对症治疗后有所改善。结肠镜检查显示结肠多处黏膜糜烂和水肿，结肠病理组织EB病毒编码小RNA 1/2原位杂交阳性（20/HP），外周血EBV-DNA阳性。诊断为CAEBV结肠炎。给予患者地塞米松和阿昔洛韦治疗后病情好转。遗憾的是，患者出院后未进行门诊随访，1年后类似症状复发，结肠镜检查和病理检查结果相似。地塞米松治疗后症状缓解。
该病例突出了CAEBV结肠炎非特异性临床表现带来的诊断挑战，对于反复腹泻和发热的患者应将其纳入鉴别诊断，以避免误诊。
