Papers of the Week

Bloody stool with fever may always be considered as inflammatory bowel disease or intestinal tuberculosis. Epstein-Barr virus (EBV) infection is common. But EBV-positive lymphoproliferative disease (EBV-LPD) involvement of gut is pretty rare and is hardly taken into consideration. A 34-year-old woman was admitted to our hospital for bloody stools over one month and fever over one week with multiple black brown nodular erythema on face. With the electronic colonoscope, intestinal tuberculosis was considered firstly, but Crohn's disease and lymphoma cannot be ruled out. So the patient received diagnostic anti-tuberculosis therapy on Aug. 2, 2012. After 8 months of antituberculosis therapy and drug withdrawal for 4 months, the patient developed symptoms of umbilicus pain accompanied with vomit, diarrhea and hyperpyrexia up to 40.3°C. The discomfort didn't get complete remission after symptomatic treatment. And on Apr. 20, 2015, colonoscopy showed multiple ulcers in colon, so inflammatory bowel disease was considered firstly. As a result, the patient was treated with Mesalazine. However, there was little symptomatic improvement and more black brown nodular erythema occurred on her face. Then on Jun. 11, 2015, she underwent colonoscopy again and the immunohistochemical of intestinal tissue suggested EB virus infection. What's more, we found serum EB virus IgM: – S/CO, serum EB virus IgG: + 12.5 S/CO, blood EBV-DNA: 5.71*10E5/mL (0-500). Furthermore, on Jun. 25, 2015, skin biopsy showed (forehead) T lymphocytes hyperplasia and focal necrosis, according with characteristics of EBV related T lymphocyte proliferative disease (EBVT-LPD). Ultimately, we got definitive diagnosis of the patient: 1. EBV-LPD, hydroa vacciniforme-like lymphoma. 2. Multiple ulcers in small intestine and colon: according with EBV-LPD. And she was treated with definitive therapy. This case shows we must consider rare disease for patients accompanied by gastrointestinal symptoms with conventional treatment ineffectively.