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. 2025 May;59(3):188-194.
doi: 10.4132/jptm.2025.02.21. Epub 2025 Apr 16.

Histopathological characteristics of Epstein-Barr virus (EBV)-associated encephalitis and colitis in chronic active EBV infection

Betty A Kasimo  1 , James J Yahaya  2 , Sun Och Yoon  3 , Se Hoon Kim  3 , Minsun Jung  3
Affiliations

Histopathological characteristics of Epstein-Barr virus (EBV)-associated encephalitis and colitis in chronic active EBV infection

Betty A Kasimo et al. J Pathol Transl Med. 2025 May.

Abstract

Chronic active Epstein-Barr virus (CAEBV) can induce complications in various organs, including the brain and gastrointestinal tract. A 3-year-old boy was referred to the hospital with a history of fever and seizures for 15 days. A diagnosis of encephalitis based on computed tomography (CT) and magnetic resonance imaging findings and clinical correlation was made. Laboratory tests showed positive serology for Epstein-Barr virus (EBV) and negative for Rotavirus antigen and IgG and IgM antibodies for cytomegalovirus, herpes simplex virus, and varicella zoster virus, respectively. Abdominal CT showed diffuse wall thickening with fluid distension of small bowel loops, lower abdomen wall thickening, and a small amount of ascites. The biopsy demonstrated positive Epstein-Barr encoding region in situ hybridization in cells within the crypts and lamina propria. The patient was managed with steroids and hematopoietic stem cell transplantation (HSCT). This case showed histopathological characteristics of concurrent EBV-associated encephalitis and colitis in CAEBV infection. The three-step strategy of immunosuppressive therapy, chemotherapy, and allogeneic HSCT should be always be considered for prevention of disease progression.

Keywords: Colitis; Encephalitis, viral; Epstein-Barr virus infections; Lymphoproliferative disorders.

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Conflict of interest statement

Conflicts of Interest

S.H.K., a contributing editor of the Journal of Pathology and Translational Medicine, was not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
(A) Magnetic resonance imaging showing swollen and multifocal T2 high signal intensity with swelling of the basal ganglia, thalamus, midbrain, pons, cerebellum, and left hypothalamus. (B) Brain tissue sections showing focal perivascular and subarachnoid lymphocyte infiltration and focal microglial cell proliferation. (C) CD3-positive T- lymphocytes infiltrating the perivascular area. (D, E) In situ hybridization of Epstein-Barr encoding region and CD8-positive Epstein-Barr virus double-staining cells from the brain tissue.
Fig. 2.
Fig. 2.
(A) Gross appearance of the ileocecectomy specimen with appendix attached, the mucosa surface showing multiple ulcerative lesions in the cecum. (B) The ileocecectomy specimen demonstrating infiltration of the lymphocytes, neutrophils, and plasma cells in the lamina and widespread neutrophilic cryptitis, crypt abscess, and distortion. (C, D) CD3-positive Epstein-Barr encoding region (EBER) in situ hybridization cells from the colon tissue (EBER antibody staining).
Fig. 3.
Fig. 3.
The serum Epstein-Barr virus (EBV) titers before and after hematopoietic stem cell transplantation.
See this image and copyright information in PMC

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