Blanco, Paola, MD

Magdaleno, Travis, MD

Nellis, Eric, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineEpstein-Barr Virus Mucocutaneous Colonic Ulcerin an Immunocompetent Patient.Travis Magdaleno MDLehigh Valley Health Network, travis.magdaleno@lvhn.orgEric Nellis MDLehigh Valley Health Network, eric.nellis@lvhn.orgPaola Blanco MDLehigh Valley Health Network, Paola_G.Blanco@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/medicinePart of the Gastroenterology Commons, and the Medical Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtMagdaleno, T. Nellis, E. Blanco, P. (2017, October 13). Epstein-Barr Virus Mucocutaneous Colonic Ulcer in an Immunocompetent Patient.Poster Presented at: The American College of Gastroenterology, Orlando, FL.© 2017 Lehigh Valley Health Network •  Epstein Barr Virus (EBV) positive mucocutaneous ulcers (MCU) were first described in 2010 in immunosuppressed patients occurring in the mouth, skin, and GI tract1 •  Lesions are described as shallow, sharply circumscribed mucosal or cutaneous ulcers2   −  Histology notes polymorphous infiltrates of lymphocytes and immunoblasts with EBER1-positive features2 •  Typically EBVMCU are treated conservatively, and resolve with reversal of immunosuppression1,2,3 •  Some reports have described an association with disseminated Hodgkin’s Lymphoma and diffuse large B-cell lymphomas (DLBCL)2,3 •  We report a case of an EBVMCU discovered in an immunocompentent patient superimposed with acute campylobacter colitis with serologic evidence of recent EBV infectious mononucleosisEpstein Barr Virus Mucocutaneous Colonic Ulcer in anImmunocompetent Patient References:1.  Dojcinov SD, Venkataraman G, Raffeld M, Pittaluga S, Jaffe ES. EBV positive mucocutaneous ulcer--a study of 26 cases associated with various sources of immunosuppression. Am J Surg Pathol. 2010;34(3):405-417.2.  Roberts TK, Chen X, Liao JJ. Diagnostic and therapeutic challenges of EBV-positive mucocutaneous ulcer: a case report and systematic review of the literature. Exp Hematol Oncol. 2015;5:13. 3.  Moran NR, Webster B, Lee KM, et al. Epstein Barr virus-positive mucocutaneous ulcer of the colon associated Hodgkin lymphoma in Crohn’s disease. World J Gastroenterol. 2015;21(19):6072–6076. 4.  Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20): 2375-90.  •  A 47 year-old male with no PMH presented with a 1-month history of bloody diarrhea with a recent development of pharyngitis with flu-like symptoms 1 week prior •  Physical exam noted pharyngeal erythema, symmetrical bilateral cervical lymphadenopathy, and diffuse abdominal tenderness •  Admission labs were significant for a normal hemoglobin, leukocytosis with a lymphocytic predominance, and LFT abnormalities •  CT of his abdomen and pelvis revealed circumferential rectal wall thickening with stranding in the setting of diffuse abdominal lymphadenopathy, splenomegaly, and multiple hepatic lesions. Radiographically concerning for malignancy •  As of April 2016, 51 cases of EBVMCU has been described in the literature2   −  5 cases described colonic involvement •  All reports have been associated with immunosuppression by either medication or age-related immunosenescence in patients over the age of 602 •  The majority of cases were self-limited and resolved with reversal of immunosuppression. Rare cases were treated with Rituximab or with surgical resection. One case was treated with chemotherapy (R-CHOP) however all cases reported complete remission3 •  Described here is a rare case in which a colonic EBVMCU was discovered within a young otherwise healthy male during acute campylobacter colitis with serologic evidence of recent infectious mononucleosis  •  Although in previous literature, EBVMCU were reported to fall within the spectrum of EBV-associated proliferative disorders, the 2016 WHO update of the classification of lymphoid neoplasms have recognized EBVMCU as a separate entity from EBV positive DLBCL due to their observed self-limited growth and response to conservative management2,4DISCUSSION •  Serum AFP, CEA, CA 19-9 were within normal limits. HIV screen were negative. Fecal calprotectin was noted to be over 830ug/g •  Further evaluation with a hepatic MRI noted liver cysts. Stool cultures were positive for Campylobacter •  He was treated with azithromycin however symptoms persisted •  Colonoscopy revealed several clean-based ulcers within the rectum and sigmoid colon (Figure 1) •  Biopsies were positive for EBVMCU (Figure 2). Serum EBV serologies indicated recent EBV infection •  Symptoms eventually improved and patient was discharged in stable condition with recommended outpatient follow-up 1Department of Medicine, 2Department of Gastroenterology, Lehigh Valley Health Network, Allentown, PennsylvaniaTravis Magdaleno DO1, Eric Nellis MD2, and Paola Blanco MD2INTRODUCTIONCASE REPORTFigure 1: Colonoscopy acquired images depicting several clean based rectal ulcers Figure 2: (Left) H&E stain of rectal ulcer noting colonic mucosa with dense lymphoplasmacyctic infiltrate. (Right) EBV in situ hybridization indicating presence of EBV DNA within the nuclei of infected cells. 

Epstein-Barr Virus Mucocutaneous Colonic Ulcer in an Immunocompetent Patient.

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=2451&context=medicine

Epstein-Barr Virus Mucocutaneous Colonic Ulcer in an Immunocompetent Patient.

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