Clinical Features of Intestinal Ulcers Complicated by Epstein-Barr Virus Infection: Importance of Active Infection.

Yuyuan Liu,Yuqin Li,Shuang Wu,Chuan He,Haibo Sun,Tongyu Tang,Yajun Li,Xinyue Tian,Yuzhen Xu

doi:10.1155/2021/6627620

Yuyuan Liu, Yuqin Li + Show 7 more

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https://doi.org/10.1155/2021/6627620

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Abstract

Clinical characteristics of intestinal ulcers complicated with Epstein-Barr virus (EBV) infection remain poorly studied. This study is aimed at providing further insight into clinical features of this patient cohort. The presence of serum EBV DNA was assessed in 399 patients with colonic ulcers, of which 30 cases were positive. In EBV-positive patients, the EBV-encoded RNA (EBER) was detected in intestinal tissues of 13 patients (EBER-positive group). The test was negative in 17 patients (EBER-negative group). Acute EBV infection rate in patients with colonic ulcer was 7.52%. Age and sex differences between two groups were not statistically significant. Fever, abdominal lymph node enlargement, and crater-like gouged ulcer morphology were more common in the EBER-positive group (P < 0.05). The albumin level in the EBER-positive group was significantly lower compared to that in the EBER-negative group (P < 0.05). The copy count of EBV DNA in the blood of patients from the EBER-positive group was higher, and the prognosis was worse (P < 0.05). Clinical manifestations were more severe in the EBER-positive group. Endoscopic, histopathological, and biochemical findings were also more serious in this group of patients. The findings point to the importance of assessing the EBER expression in patients with intestinal ulcers of various etiology. EBER positivity should be viewed as a diagnostic marker of more severe condition requiring more aggressive treatment.

Highlights

Epstein-Barr virus (EBV), known as human herpesvirus4 (HHV-4), is a double-stranded DNA virus of the herpesvirus family [1]
Intestinal EBV infection can be manifested by nonspecific symptoms such as fever, hematochezia, abdominal pain, and diarrhea, which are difficult to distinguish from inflammatory bowel disease (IBD) and can be misdiagnosed, with serious consequences
After excluding the patients with incomplete laboratory data, those without blood EBV DNA test, those without the results of enteroscopic examination, and those diagnosed with intestinal lymphomas, the detailed clinical data of 30 hospitalized patients with colorectal ulcers complicated by EB viremia were analyzed retrospectively

Summary

Introduction

Epstein-Barr virus (EBV), known as human herpesvirus (HHV-4), is a double-stranded DNA virus of the herpesvirus family [1]. Primary EBV infection usually occurs in childhood. More than 90% of adults have EBV infection which persists for a lifetime. Most of these infections are selflimited or cause infectious mononucleosis (IM) [2]. Intestinal EBV infection can be manifested by nonspecific symptoms such as fever, hematochezia, abdominal pain, and diarrhea, which are difficult to distinguish from inflammatory bowel disease (IBD) and can be misdiagnosed, with serious consequences. EBV infection makes people more likely to develop IBD, which may lead to persistent inflammation and inadequate response to conventional treatment. IBD increases the risk of intestinal EBV infection [5,6,7]

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