Rationale: Chronic active Epstein–Barr virus (EBV) disease is a group of refractory and progressive lymphoproliferative disorders characterized by both inflammatory and clonal proliferative features. Gastrointestinal involvement is highly uncommon and can often be misdiagnosed as inflammatory bowel disease. Patient concerns: A 63-year-old man presented with diarrhea and bloody stools and was initially diagnosed with ulcerative colitis at a local hospital. After multiple courses of biologic therapy, progressive development of a mass-forming lesion was observed on serial endoscopy. Diagnoses: Detection of EBV nucleic acid in serum and colon biopsies showed a high viral load. Serial pathological consultations confirmed the diagnosis of EBV-associated lymphoproliferative disorder. Positron emission tomography/computed tomography revealed disease progression involving the bone marrow, and bone marrow examination confirmed peripheral T-cell non-Hodgkin lymphoma. Interventions: Biological therapy was discontinued. Allogeneic hematopoietic stem cell transplantation was recommended, but the patient declined. After progression to lymphoma occurred, chemotherapy was administered. Outcomes: The patient responded poorly to chemotherapy, with rapid disease progression, and ultimately succumbed to multisystem organ failure. Lessons: This rare case underscores the critical importance of differentiating between chronic active EBV-associated enteritis and inflammatory bowel disease, as their management strategies and prognoses are divergent. The clinical course of chronic active EBV-associated enteritis is aggressive, and the prognosis is poor. Misdiagnosis may delay treatment and potentially accelerate disease progression.
Yang et al. (Fri,) studied this question.