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Case Reports
. 2018 Jun 29:2018:bcr2018224963.
doi: 10.1136/bcr-2018-224963.

EBV colitis with ulcerative colitis: a double whammy

Muhammad Afzal  1 , Gaurav Bhaskar Nigam  1
Affiliations
Case Reports

EBV colitis with ulcerative colitis: a double whammy

Muhammad Afzal et al. BMJ Case Rep. .

Abstract

We report this case of a 21-year-old immunocompetent man presenting with ulcerative colitis and superimposed Epstein-Barr virus (EBV) colitis. He presented for the first time with symptoms of blood-mixed diarrhoea and raised inflammatory markers. His endoscopic and histological appearances were found to be due to ulcerative colitis for which he was started on standard therapy with intravenous steroids. In spite of this, he continued to be symptomatic and his inflammatory markers continued to rise. A virology screen done showed evidence of previous EBV infection, and in view of poor response to immunosuppression, a superimposed infection was suspected. EBV DNA PCR done on colonic biopsies was found to be positive and the patient was started on intravenous ganciclovir to which he responded well. This case highlights the importance of considering a superimposed infection in patients with poor initial response to steroid therapy in inflammatory bowel disease.

Keywords: gastrointestinal system; infections; ulcerative colitis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Sigmoidoscopy picture showing extensive moderate erythema, mucopurulent exudates and ulceration extending from the rectum to the proximal sigmoid.
Figure 2
Figure 2
Epstein-Barr virus positive lymphocytes seen in lamina propria and submucosa on immunohistochemistry and in situ hybridisation.
See this image and copyright information in PMC

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