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

Seung Hyun Oh; Chan Ran You; Eun Ok Kim; Si Hyun Bae; Jong Young Choi; Seung Kew Yoon; Sang Wook Choi

doi:10.4166/kjg.2016.68.2.104

Journal List > Korean J Gastroenterol > v.68(2) > 1007544

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Oh, You, Kim, Bae, Choi, Yoon, and Choi: A Case of Ulcerative Colitis Following Acute Hepatitis Induced by Epstein-Barr Virus Infection

Case Report

Korean J Gastroenterol 2016;68(2):104-108.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.2.104

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

Seung Hyun Oh, Chan Ran You, Eun Ok Kim, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Sang Wook Choi

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Chan Ran You, Department of Internal Medicine, The Catholic University of Korea, St. Paul's Hospital, 180 Wangsan-ro, Dongdaemun-gu, Seoul 02559, Korea. Tel: +82-2-958-2114, Fax: +82-2-968-7250, E-mail: ran_you@catholic.ac.kr

Received 28 November 2014 Revised 1 June 2016 Accepted 2 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Hepatitis, Epstein-Barr virus, Epstein-Barr virus infections, Ulcerative colitis

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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.

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