EBV-Induced Hepatitis and Juvenile Gangrenous Vasculitis: A Case Report

Introduction: Juvenile gangrenous vasculitis (JGV) is a rare painful scrotal ulceration with less than 20 cases reported in the literature.The peak incidence is estimated between 5 and 45 years old.Patients usually report scrotal itching, stinging, burning or pain and these symptoms precede the development of lesions or ulcers.The etiology is unknown and in most cases no underlying infection can be identified Case: A 29 years old male, previously healthy, presented for a three newly appearing scrotal ulcers.The patient was febrile 4 days ago and had sore throat, severe fatigue and decrease appetite without other gastrointestinal symptoms.His physical examination was pertinent for the presence of multiple pharyngeal ulcerations, a 1 cm retro-auricular adenopathy, with mild tenderness on the right upper quadrant and the presence of 3 active and painful scrotal ulcers.The EBV-VCA IgM was positive 160 U/mL (Negative < 20) confirming the presence of an acute EBV infection.Discussion: A young patient presented with symptoms of pharyngitis, scrotal ulcer, increase in WBC, thrombocytopenia, and a perturbated liver enzymes.Workup for all viral hepatitis (A, B, C, EBV and CMV) was done to rule out hepatitis.The history of pharyngitis, the presence of thrombocytopenia, perturbated liver enzymes and hepato-splenomegaly on abdominal ultrasound was highly suggestive of EBV induced pharyngitis and hepatitis and was confirmed with the presence of a positive IgM EBV-VCA serology.A painful scrotal ulcer was noted suggestive of JGV.JGV is a rare scrotal gangrene of unknown origin characterized by acute onset of skin ulcer and affecting mainly young patients.Notably, an association between LU and EBV is described in the literature, and this was reported too in our case.The disease is self-limited and a complete resolution within 2-3 weeks is noted. Conclusion:EBV infection should be ruled out whenever a patient has disturbed liver enzymes, pharyngitis, hepatosplenomegaly and skin involvement, such as genital ulcers.Gastroenterologists should be prudent enough to exclude a diagnosis of JGV in context of EBV infection and genital involvement.JVG is a self-limited disease with a complete resolution in 2-3 weeks.