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International Journal of Colorectal Disease

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Open Access 01-05-2019 | Azathioprine | Short Communication

Clinical and endoscopic complications of Epstein-Barr virus in inflammatory bowel disease: an illustrative case series

Authors: R. L. Goetgebuer, C. J. van der Woude, L. de Ridder, M. Doukas, A. C. de Vries

Published in: International Journal of Colorectal Disease | Issue 5/2019

Abstract

Background and aim

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.

Methods

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).

Results

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.

Conclusion

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.

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Title: Clinical and endoscopic complications of Epstein-Barr virus in inflammatory bowel disease: an illustrative case series
Authors: R. L. Goetgebuer
C. J. van der Woude
L. de Ridder
M. Doukas
A. C. de Vries
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Keywords: Azathioprine
Chronic Inflammatory Bowel Disease
Epstein-Barr Virus
Hemophagocytic Lymphohistiocytosis
Azathioprine
Hemophagocytic Lymphohistiocytosis
Published in: International Journal of Colorectal Disease / Issue 5/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03257-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical and endoscopic complications of Epstein-Barr virus in inflammatory bowel disease: an illustrative case series

Abstract

Background and aim

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aim

Methods

Results

Conclusion

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