Epsein-Barr infection of the colon in a patient with first attack of severe ulcerative colitis: A case report and review of the literature

Abstract

Epstein-Barr virus infection is related to oral carcinoma,beta-lymphocytic lymphoma, oral leucoplacia and sarcoidosis. To the best of our knowledge there are no case reports describing concurrent appearance of severe ulcerative colitis and infection with Epstein-Barr virus. Aim: The aim of this study was to present a patient with severe first attack of total ulcerative colitis and concurrent infection of the inflamed bowel mucosa with Epstein-Barr virus. Case report: A man aged 34, was admitted to our department complaining of bloody diarrhoea, fever, abdominal pain and fatigue of one month duration. The diagnosis of total ulcerative colitis was based on the endoscopic and histological picture of the colon mucosa, as well as on the exclusion of other causes of colitis, mainly of infectious origin. The situation of the patient improved slowly over the next few days after application of prednizolone 1mg/KgBW per day, and metronidazole and ciprofloxacin for the first 5 days. However, clinical symptoms reappeared after 2 weeks while the patient was on reduced doses of prednizolone with the main clinical symptoms being bloody diarrhoea, abdominal pain, severe anaemia, and hypoalbuminemia.Both, serum antibodies against cytomegalovirus and polymerase chain reaction assay on the large bowel mucosa for CMV were negative. However, search for the presence of Epstein-Barr in the bowel mucosa (polymerase chain reaction) became positive. The patient improved considerably with antivirus treatment while the administration of prednizolone was continued. The source of the infection was probably his wife, as she developed severe infectious mononucleosis some weeks before. In the follow-up period of two years another exacerbation of colitis of moderate severity appeared which was settled promptly. Conclusion: Infection with Epstein-Barr virus could complicate the course of patients with severe attack of ulcerative colitis. The exact role of this co-infection on the pathogenesis and course of ulcerative colitis remains obscure.