加齢による免疫低下によって生じたと考えられたEpstein-Barrウイルス陽性粘膜皮膚潰瘍の1例

• Published in: 日本口腔外科学会雑誌 Vol. 67; no. 1; pp. 35 - 39
• Main Authors: 阿部, 幸二郎, 山下, 知巳, 林, 樹, 牧田, 浩樹, 山田, 浩太, 土井田, 誠
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.01.2021
• Subjects: EBウイルス陽性粘膜皮膚潰瘍; 加齢性免疫低下; 医原性免疫抑制; 自然寛解
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.67.35

Epstein-Barr virus (EBV) -positive mucocutaneous ulcer (EBVMCU) was first described as a lymphoproliferative disorder in 2010. It is recognized as a mature B-cell tumor in the 2017 WHO classification. EBVMCU results from iatrogenic or age-related immunosuppression and it appears clinically as a localized, well-demarcated ulcerative lesion at the cutaneous or mucosal sites. Histologically, EBVMCUs are characterized by the proliferation of EBV-positive atypical B-cells. In situ hybridization for EBV-encoded small RNA (EBER) reveals many positive cells. Most cases resolve with a reduction in immunosuppression, and some lesions spontaneously resolve. We report a case of EBVMCU that affected the maxillary gingiva. The patient was an 86-year-old woman with an ulcer in the palatal gingiva of the first molar region. At the initial consultation, a biopsy was performed, and we started administration of azithromycin (AZM) at 500 mg/day for 3 days because the left first molar had marginal periodontitis. Immunohistochemistry revealed positive reactions for CD20, CD30, and CD79a, and EBV-encoded small RNA (EBER) was found in many positive cells, which revealed EBVMCU. Because it was considered to have been caused by immune reduction due to aging, follow-up was selected as the treatment strategy. Basic periodontal treatment and oral cleaning instructions were provided in parallel with the follow-up observation. The patient had a spontaneous remission two months after the initial consultation. No recurrence was observed one year after the initial consultation．