Korean J Gastroenterol.  2016 Aug;68(2):104-108. 10.4166/kjg.2016.68.2.104.

A Case of Ulcerative Colitis Following Acute Hepatitis Induced by Epstein-Barr Virus Infection

• Oh SH
• You CR
• Kim EO
• Bae SH
• Choi JY
• Yoon SK
• Choi SW

• KMID: 2350088
• DOI: http://doi.org/10.4166/kjg.2016.68.2.104

Abstract

Epstein-Barr virus (EBV) infection varies in its clinical manifestations and severity. EBV can be a causative agent of hepatitis and may have a role in the pathogenesis of chronic autoimmune diseases including inflammatory bowel disease. A 24-year-old woman was admitted to our hospital, presenting with fever and elevated liver enzymes. She was diagnosed with acute hepatitis and EBV infection according to serologic tests and liver biopsy. Within two months, she was re-admitted to our hospital, presenting with hematochezia and lower abdominal pain. She was diagnosed with ulcerative colitis. In situ hybridization for EBV was positive in initial liver biopsy and colon biopsy. Here we report an unusual case of acute EBV hepatitis followed at a short interval by ulcerative colitis.

Keyword

Hepatitis; Epstein-Barr virus; Epstein-Barr virus infections; Ulcerative colitis

MeSH Terms

Abdominal Pain
Autoimmune Diseases
Biopsy
Colitis, Ulcerative*
Colon
Epstein-Barr Virus Infections
Female
Fever
Gastrointestinal Hemorrhage
Hepatitis*
Herpesvirus 4, Human*
Humans
In Situ Hybridization
Inflammatory Bowel Diseases
Liver
Serologic Tests
Ulcer*
Young Adult

Figure

• 

  Fig. 1. Initial liver biopsy findings. (A) H&E (×100). Intralobular focal necrosis and infiltration of inflammatory cells in portal area are shown. A linear sinusoidal lymphocytic infiltration is also seen. (B) Epstein-Barr virus in situ hybridization (×400). Positive staining cells (blue color) were detected within lymphocytes infiltrating in periportal area.

• 

  Fig. 2. (A, B) Colonoscopic images of sigmoid colon at second admission. Loss of vascular pattern and some friability of the mucosa is seen. (C, D) Follow-up colonoscopic images of sigmoid colon and rectum after one year. This image shows multiple mucosal erosions, loss of vascular appearance and an inflammatory polyp (arrow).

• 

  Fig. 3. Microsopic findings of colon biopsy. (A) H&E (×400). The infiltration of mixed inflammatory cells and acute cryptitis (arrow) are shown. (B) Epstein-Barr virus in situ hybridization (×400). Positive staining cells (blue color) were detected within lymphocytes infiltrating in area of active inflammation.

Reference

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