Liver and colonic manifestation of active chronic infection by Epstein Barr virus

• Published in: Andes pediatrica : revista Chilena de pediatría Vol. 93; no. 3; pp. 416 - 422
• Main Authors: Sabillón-Mendoza, Alejandra Maricela, Imbett-Yepez, Sharon María, Ignorosa-Arellano, Karen, Cadena-León, Jose Francisco, Zárate-Mondragón, Flora, Cervantes-Bustamante, Roberto, Ramírez-Mayans, Jaime
• Format: Journal Article
• Language: Spanish
• Published: 01.06.2022
• ISSN: 2452-6053
• DOI: 10.32641/andespediatr.v93i3.3676

INTRODUCTIONChronic active Epstein Barr virus infection (CAEBV) is a rare condition, where the body is unable to counteract Epstein Barr viral replication (EBV), leading the patient to a chronic state with variable symptoms. Early recognition of infrequent or atypical clinical manifestations is relevant due to the particularities of their management and prognosis. OBJECTIVEto describe a case of CAEBV manifes ted with colitis and hepatitis, summarizing the clinical-pathological and endoscopic characteristics and their evolution. CLINICAL CASEA 6-year-old girl, previously healthy, presented recurrent episodes of jaundice, hepatosplenomegaly, and fever. EBV hepatitis was diagnosed with a blood viral load of 328,000 copies / mL. Her liver biopsy revealed Epstein-Barr virus-encoded small RNAs (EBER). She evolved with mucosanguineous diarrhea and weight loss; the colonoscopy showed loss of the haustral pattern, multiple aphthous ulcers covered with fibrin, and 7 million copies of EBV / gram of tissue were found in the colon. T-cell lineage infection was identified, therefore Rituximab was started, with a decrease in viral load, complete resolution of diarrhea, and improvement in liver function tests. The definitive treatment was bone marrow transplantation. CONCLUSIONSCAEBV is a serious disor der, little documented, and should be considered in the face of a prolonged or intermittent course of hepatitis, accompanied by general and gastrointestinal manifestations such as chronic diarrhea, hematochezia, and weight loss, since its outcome without treatment can be fatal.