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1.
Medicine (Baltimore) ; 99(3): e18764, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011464

RESUMO

RATIONALE: Epstein-Barr virus (EBV)-associated T-cell lymphoproliferative disorder (LPD) usually occurs in children and young adults. Gastrointestinal involvement is rare. EBV-associated T-cell lymphoproliferative disorder manifesting as intestinal ulcers poses diagnostic challenges clinically and pathologically because of the atypical manifestations. We concluded that some indicators according to our case and literatures, which might be helpful to the diagnosis of EBV-associated LPD manifested as intestinal ulcers. PATIENT CONCERNS: Here we present a 26-year-old man with complaints of diarrhea and abdominal pain that had persisted for 1 year. Multiform and multifocal deep ulcers were discovered in the colonoscopy. Cell atypia was not obvious but colitis with crypt distortion was found in pathology. DIAGNOSES: According to the symptoms, laboratory examinations, colonoscopy and pathology results, Crohn Disease was diagnosed. INTERVENTIONS: Infliximab therapy was initiated based on the diagnosis of Crohn Disease. OUTCOMES: After the fifth course of therapy, intermittent fever and hematochezia occurred. Physical examination revealed swollen tonsils and ulcers, and purulent exudate from the right tonsil and palatoglossal arch were observed. Biopsies obtained through colonoscopy and nasopharyngoscopy demonstrated EBV-associated T-cell proliferation disease (level 3). After that, the tissue sample from the first colonoscopy was reexamined immunohistochemically. The result suggested EBV-associated T-cell proliferation disease (level 1). LESSONS: When we confront with patients with multiform and multifocal deep intestinal ulcers, not only the common diseases such as Crohn Disease and intestinal tuberculosis should be considered, EBV-associated T-cell proliferation disease should be considered as well. Repeated multiple biopsy, gene rearrangement, EBV DNA quantitative analysis result, EBV-encoded RNA(EBER) and experienced pathologists might be helpful to the diagnosis.


Assuntos
Doença de Crohn/virologia , Infecções por Vírus Epstein-Barr/complicações , Transtornos Linfoproliferativos/virologia , Tonsilite/virologia , Úlcera/virologia , Adulto , Colonoscopia , Diagnóstico Diferencial , Humanos , Masculino
3.
PLoS One ; 14(4): e0215487, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31009486

RESUMO

OBJECTIVES: To investigate the epidemiology of herpes simplex virus type 1 (HSV-1) in Latin America and the Caribbean. METHODS: Systematic review and meta-analytics guided by the Cochrane Collaboration Handbook and reported following the PRISMA guidelines. RESULTS: Thirty-three relevant reports were identified including 35 overall (and 95 stratified) seroprevalence measures, and five and nine proportions of virus isolation in genital ulcer disease (GUD) and in genital herpes, respectively. Pooled mean seroprevalence was 57.2% (95% CI: 49.7-64.6%) among children and 88.4% (95% CI: 85.2-91.2%) among adults. Pooled mean seroprevalence was lowest at 49.7% (95% CI: 42.8-56.6%) in those aged ≤10, followed by 77.8% (95% CI: 67.9-84.8%) in those aged 10-20, 82.8% (95% CI: 73.1-90.8%) in those aged 20-30, 92.5% (95% CI: 89.4-95.1%) in those aged 30-40, and 94.2% (95% CI: 92.7-95.5%) in those aged ≥40. Age was the strongest source of heterogeneity in seroprevalence, explaining 54% of variation. Evidence was found for seroprevalence decline over time. Pooled mean proportion of HSV-1 isolation was 0.9% (95% CI: 0.0-3.6%) in GUD and 10.9% (95% CI: 4.4-19.4%) in genital herpes. CONCLUSIONS: HSV-1 is a widely prevalent infection in this region, but its epidemiology may be slowly transitioning, with still limited contribution for HSV-1 in genital herpes.


Assuntos
Herpes Genital/epidemiologia , Herpes Simples/epidemiologia , Herpesvirus Humano 1/isolamento & purificação , Úlcera/epidemiologia , Região do Caribe/epidemiologia , Feminino , Herpes Genital/diagnóstico , Herpes Genital/virologia , Herpes Simples/diagnóstico , Herpes Simples/virologia , Herpesvirus Humano 1/fisiologia , Humanos , América Latina/epidemiologia , Masculino , Estudos Soroepidemiológicos , Úlcera/diagnóstico , Úlcera/virologia
5.
Clin J Gastroenterol ; 12(4): 330-335, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30903514

RESUMO

Epstein-Barr virus (EBV)-positive mucocutaneous ulcer is a B-cell lymphoproliferative disorder occurring in elderly or iatrogenic immunocompromised patients. We report a 27-year-old male patient with Crohn's disease (CD) who developed immunomodulator-associated lymphoproliferative disorder. The patient was diagnosed with CD at the age of 17 and was treated with maintenance therapy including high-dose infliximab and azathioprine. When he was admitted to our hospital with a diagnosis of intestinal obstruction, his abdominal computed tomography findings showed not only colonic wall thickening and narrowing of the descending colon but also multiple liver tumor lesions. His ileus symptom improved with conservative therapy, and a pathological evaluation of the tissue biopsy specimens from the descending colon and liver lesions indicated a morphological diagnosis of EBV-positive diffuse large B-cell lymphoma. This was a case of iatrogenic immunodeficiency-associated lymphoproliferative disorder due to an immunomodulator. The treatment was initiated with chemotherapy, but he died of disease progression 10 months after the diagnosis of lymphoma. Although cases of lymphoproliferative disorder due to treatment modalities used for CD are rare in Japan, an increase in the risk of lymphoproliferative diseases should be considered in patients with CD treated with immunomodulatory agents.


Assuntos
Doença de Crohn/tratamento farmacológico , Infecções por Vírus Epstein-Barr/complicações , Imunossupressores/efeitos adversos , Linfoma Difuso de Grandes Células B/virologia , Adulto , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/imunologia , Neoplasias do Colo/virologia , Colonoscopia , Doença de Crohn/imunologia , Infecções por Vírus Epstein-Barr/imunologia , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/imunologia , Neoplasias Hepáticas/virologia , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/imunologia , Masculino , Tomografia Computadorizada por Raios X , Úlcera/imunologia , Úlcera/virologia
6.
J Eur Acad Dermatol Venereol ; 33(9): 1660-1666, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30903712

RESUMO

Since its first description as ulcus vulvae acutum by Benjamin Lipschütz in 1912, the etiopathogenesis of this peculiar genital ulcer remains incompletely understood. In his original description, two different types of genital ulcers were observed and proposed, which were not precisely defined and distinguished in most subsequent reports. The first type is characterized by acute excruciating genital ulcers of first-time onset with self-limited non-recurrent course in association with gravely symptomatic systemic infections, in which a primary Epstein-Barr virus (EBV) infection is later identified to be probably the most common aetiology. The second type of ulcer usually refers to little painful ulcers of unknown etiopathogenesis in the absence of fever or chills and with a slow torpid progression and recurrent nature. Differentiation from idiopathic aphthous ulcers is unclear. The changes of the cervicovaginal microbiota and microbiome in diseased state deserve further clarification. Acute genital ulcers associated with primary EBV infection in women have drawn attention since 1970s, while the corresponding penile ulcers in men were already known in 1950s. First presented in 1973, juvenile gangrenous vasculitis of the scrotum with an acute painful scrotal ulcer preceded by symptomatic pharyngeal infections can be considered as the male counterpart of ulcus vulvae acutum, and the future clinical survey should include primary EBV infection.


Assuntos
Infecções por Vírus Epstein-Barr/virologia , Gangrena/virologia , Doenças dos Genitais Masculinos/virologia , Escroto/virologia , Úlcera/virologia , Vasculite/virologia , Criança , Feminino , Humanos , Masculino , Doenças da Vulva/virologia
7.
BMJ Case Rep ; 12(2)2019 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-30739086

RESUMO

A 42-year-old woman with a history of cholangiocarcinoma on adjuvant chemotherapy with capecitabine presented with painless haematochezia. She was found to have an isolated twenty-five mm ulcer in the ascending colon. Biopsies of the ulceration demonstrated typical cytomegalovirus (CMV) inclusions and her peripheral blood CMV PCR was significantly elevated. This is an unusual case of a solitary proximal colon ulcer. Non-steroidal anti-inflammatory drugs, inflammatory bowel disease and malignancy, are the most frequent causes of isolated ulcers in the proximal colon. Gastrointestinal (GI) CMV disease most commonly causes CMV colitis and is considered rare outside of the transplant population and other severely immunosuppressed patient groups. Patients who have received chemotherapy may also be at risk for GI CMV disease. The diagnosis should be suspected in patients who present with haematochezia or watery diarrhoea within a broad window of time after receiving chemotherapy.


Assuntos
Colite/diagnóstico , Colo Ascendente/patologia , Infecções por Citomegalovirus/diagnóstico , Úlcera/diagnóstico , Adulto , Antimetabólitos Antineoplásicos/efeitos adversos , Antivirais/uso terapêutico , Neoplasias dos Ductos Biliares/tratamento farmacológico , Capecitabina/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Colangiocarcinoma/tratamento farmacológico , Colite/complicações , Colite/patologia , Colite/virologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/patologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hospedeiro Imunocomprometido/imunologia , Pancreaticoduodenectomia , Fatores de Risco , Úlcera/complicações , Úlcera/patologia , Úlcera/virologia , Valaciclovir/uso terapêutico
9.
Pathol Int ; 69(1): 21-28, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30615240

RESUMO

Methotrexate (MTX) is currently used as first-line anchor drug for rheumatoid arthritis (RA). Therefore, the number of MTX-associated lymphoproliferative disorders, including Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU), has increased. Some aspects of MTX-associated EBVMCU (MTX-EBVMCU), particularly clinical behavior and treatment for RA after MTX cessation, have not been well described. Herein, we report nine cases of MTX-EBVMCU with clinical information regarding RA. Seven of nine patients showed spontaneous regression (SR) after immunosuppressive (IS) cessation. The other two required cytotoxic chemotherapy. Eventually, all achieved complete remission. No patients experienced EBVMCU relapse. Eight patients had RA flare after IS cessation. To control the RA activity, rituximab was administered to three patients. The remaining patients were treated by other agents. Regarding the RA activity, all were in the status of low disease activity or clinical remission. In conclusion, MTX-associated EBVMCU has an indolent clinical course and SR after IS cessation can be expected. After the withdrawal of MTX, the majority of patients experience RA flare and required treatment. In our series, RA was well controlled without reinitiating MTX. Therefore, to prevent the EBVMCU relapse, it might be advisable to avoid MTX reintroduction, and rituximab might be the more preferable agent for RA treatment.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Imunossupressores/efeitos adversos , Transtornos Linfoproliferativos/etiologia , Metotrexato/efeitos adversos , Úlcera/etiologia , Idoso , Idoso de 80 Anos ou mais , Infecções por Vírus Epstein-Barr/etiologia , Infecções por Vírus Epstein-Barr/patologia , Infecções por Vírus Epstein-Barr/virologia , Feminino , Herpesvirus Humano 4/isolamento & purificação , Humanos , Imuno-Histoquímica , Imunossupressores/uso terapêutico , Transtornos Linfoproliferativos/patologia , Transtornos Linfoproliferativos/virologia , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Mucosa Bucal/virologia , Rituximab/uso terapêutico , Resultado do Tratamento , Úlcera/patologia , Úlcera/virologia
10.
Virchows Arch ; 474(1): 117-123, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30194489

RESUMO

Primary classic Hodgkin lymphoma of the gastrointestinal tract represents a rare occurrence. A full patient's work-up is essential in order to exclude a secondary intestinal involvement. Histologically Epstein-Barr virus mucocutaneous ulcer closely resembles Hodgkin lymphoma. The differential diagnosis between these two entities is relevant, since both the therapeutic approach and the clinical behavior are different. Herein, we describe a case of primary classic Hodgkin lymphoma arising in the ileum and a case of Epstein-Barr virus mucocutaneous ulcer of the colon, focusing on the main clinicopathological differences.


Assuntos
Doenças do Colo/patologia , Infecções por Vírus Epstein-Barr/patologia , Doença de Hodgkin/patologia , Neoplasias do Íleo/patologia , Infecções Oportunistas/patologia , Úlcera/patologia , Adulto , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Biópsia , Doenças do Colo/imunologia , Doenças do Colo/virologia , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/imunologia , Infecções por Vírus Epstein-Barr/virologia , Feminino , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/metabolismo , Humanos , Neoplasias do Íleo/química , Neoplasias do Íleo/tratamento farmacológico , Hospedeiro Imunocomprometido , Imuno-Histoquímica , Imunossupressores/efeitos adversos , Masculino , Metotrexato/efeitos adversos , Infecções Oportunistas/imunologia , Infecções Oportunistas/virologia , Valor Preditivo dos Testes , Úlcera/imunologia , Úlcera/virologia
11.
Enferm Infecc Microbiol Clin ; 37(4): 260-264, 2019 04.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30580877

RESUMO

Genital herpes is a sexually transmitted disease caused by herpes simplex virus type1 (HSV-1) and type2 (HSV-2) belonging to the alphaherpesvirus family, that includes the varicella zoster virus. HSV infection continues to be the most common cause of vulvar ulcers among the sexually active population. Its incidence increases every year. This review summarises the microbiology of the virus, pathogenesis and infection in genitalia, clinical manifestations and correct identification, the different laboratory diagnostic methods, and choice of the correct treatment according to the first infection, recurrence or special cases. Finally, the cost of routine herpes simplex virus infection is analysed.


Assuntos
Herpes Genital/complicações , Úlcera/virologia , Feminino , Herpes Genital/diagnóstico , Herpes Genital/tratamento farmacológico , Humanos , Masculino , Úlcera/diagnóstico , Úlcera/tratamento farmacológico
12.
Pathol Int ; 69(1): 37-41, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30450620

RESUMO

Elderly patients with Epstein-Barr virus (EBV) infection are at increased risk for developing B-cell lymphoproliferative disorder (B-LPD) due to immunosenescence. Here, we describe a case of a 75-year-old man who developed an EBV-positive (EBV+) mucocutaneous ulcer (EBVMCU) in the gingiva with spontaneous regression. Eighteen months after regression, he had a cervical lymph node enlargement that was diagnosed as EBV+ nodal polymorphous B-LPD, Ann Arbor stage IA. Clinicians decided to observe his clinical course without any treatment. Fourteen months later, the patient developed EBV-positive diffuse large B-cell lymphoma (DLBCL), Ann Arbor stage IIA, and received six courses of age-adjusted dose chemotherapy and achieved a complete remission. No evidence of a clonal relationship was found among these three lesions by standard polymerase chain reaction (PCR) analysis for immunoglobulin heavy chain. However, they all had expression of PD-L1 in the EBV+ large B-cells and Hodgkin Reed-Sternberg-like cells. This is the first case report of a PD-L1-positive (PD-L1+) EBVMCU and the development of multiple EBV-driven B-LPDs in the setting of immunosenescence within a 32-month period.


Assuntos
Antígeno B7-H1/metabolismo , Infecções por Vírus Epstein-Barr/patologia , Herpesvirus Humano 4/isolamento & purificação , Linfoma Difuso de Grandes Células B/etiologia , Transtornos Linfoproliferativos/etiologia , Úlcera/etiologia , Idoso , Linfócitos B/patologia , Linfócitos B/virologia , Infecções por Vírus Epstein-Barr/virologia , Gengiva/patologia , Gengiva/virologia , Humanos , Imunossenescência , Linfonodos/metabolismo , Linfonodos/patologia , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/virologia , Transtornos Linfoproliferativos/patologia , Transtornos Linfoproliferativos/virologia , Masculino , Mucosa Bucal/patologia , Mucosa Bucal/virologia , Indução de Remissão , Úlcera/patologia , Úlcera/virologia
13.
J Pediatric Infect Dis Soc ; 8(1): 73-76, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-29415165

RESUMO

Single gene defects that impair lymphocyte cytotoxicity can predispose to severe viral infection that normally remains subclinical. The classic severe presentation is hemophagocytic lymphohistiocytosis. Here, we report the case of a neonate who presented with cytomegalovirus palatal ulceration and bocavirus pneumonitis secondary to impaired cytotoxicity caused by biallelic mutations in the UNC13D gene.


Assuntos
Infecções por Citomegalovirus/imunologia , Citotoxicidade Imunológica , Bocavirus Humano/isolamento & purificação , Linfócitos/imunologia , Proteínas de Membrana/genética , Palato Duro/imunologia , Infecções por Parvoviridae/imunologia , Pneumonia Viral/imunologia , Úlcera/imunologia , Infecções por Citomegalovirus/patologia , Humanos , Recém-Nascido , Masculino , Mutação , Palato Duro/patologia , Palato Duro/virologia , Infecções por Parvoviridae/genética , Infecções por Parvoviridae/patologia , Pneumonia Viral/genética , Pneumonia Viral/patologia , Úlcera/patologia , Úlcera/virologia
14.
Indian J Med Microbiol ; 36(3): 441-443, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30429404

RESUMO

We report a case of mucocutaneous Herpes Simplex Virus (HSV)-2 and Cytomegalovirus (CMV) infection in a 39-year-old female with acquired immunodeficiency syndrome, who presented with a perigenital ulcer. The patient was receiving antiretroviral treatment (ART) for 3 months before presentation. Scraping from the perigenital ulcer was positive for HSV-2 and Treponema pallidum using polymerase chain reactions (PCR). The extent and duration of the lesions led us to consider the possibility of coinfection with CMV. The patient also tested positive for CMV by PCR. On subsequent follow-up after 8 weeks, the genital lesions had healed completely. This is possibly ascribable to the ART, which led to significant immune reconstitution.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Infecções por HIV/complicações , Herpes Genital/diagnóstico , Sífilis/diagnóstico , Úlcera/etiologia , Úlcera/patologia , Doenças da Vulva/diagnóstico , Adulto , Coinfecção/diagnóstico , Coinfecção/microbiologia , Coinfecção/patologia , Coinfecção/virologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/patologia , Feminino , Herpes Genital/complicações , Herpes Genital/patologia , Herpesvirus Humano 2/isolamento & purificação , Humanos , Reação em Cadeia da Polimerase , Sífilis/patologia , Treponema pallidum/isolamento & purificação , Úlcera/microbiologia , Úlcera/virologia , Doenças da Vulva/microbiologia , Doenças da Vulva/patologia , Doenças da Vulva/virologia
15.
Arch Gynecol Obstet ; 298(5): 927-931, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30143859

RESUMO

AIM: Lipschütz ulcers (LU) were first described as rare vulvar ulcerations that affect adolescents without previous history of sexual contact. However, more LU patients have been identified in acute genital ulcers (AGU) services in Europe. PURPOSE: To review cases of AGU and analyze the occurrence of LU in the Ob/Gyn Emergency Department of a Brazilian private hospital, using the currently used diagnostic criteria. METHODS: All female patients who sought our service with AGU complaints from January 2009 to July 2015 were selected and had their medical records reviewed, considering the clinical data and some diagnostic criteria, that included: < 20 years old, first AGU episode, sudden onset, absence of sexual contact 3 months before onset and the absence of immunodeficiency. RESULTS: 273 patients eligible for analysis were identified according to the criteria and 12 (4.39%) of them were identified with the possible diagnosis of LU. By applying less restrictive criteria that allowed the inclusion of patients of any age and sexual status, 98 were identified (35.89%). CONCLUSIONS: Despite being described as a rare pathology, ours and previous results indicate a considerable number of AGU cases, suggesting that LU should be better known and considered for differential diagnosis.


Assuntos
Úlcera/diagnóstico , Doenças da Vulva/diagnóstico , Adolescente , Adulto , Idoso , Brasil , Criança , Bases de Dados Genéticas , Diagnóstico Diferencial , Europa (Continente) , Feminino , Herpes Genital/complicações , Herpes Genital/diagnóstico , Humanos , Pessoa de Meia-Idade , Úlcera/patologia , Úlcera/virologia , Doenças da Vulva/patologia , Doenças da Vulva/virologia , Adulto Jovem
16.
Zhonghua Nei Ke Za Zhi ; 57(7): 487-493, 2018 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-29996266

RESUMO

Objective: To investigate the clinical and pathological characteristics of chronic active Epstein-Barr virus associated enteritis (CAEAE) . Methods: The clinical data of 6 CAEAE patients in Peking Union Medical College Hospital were retrospectively analyzed from January 2010 to November 2017, including clinical manifestations, endoscopic, pathological features, medications and clinical outcome. Results: The male∶female ratio was 4∶2 and the average age was 34 years old. All patients did not have personal and family history of immunodeficiency. The common symptoms consisted of fever (6/6), abdominal pain (6/6), hematochezia (6/6) and diarrhea (5/6). The most frequently affected sites were colorectum (5/6), followed by small intestine (3/6). Further serologic tests revealed a high load of serum Epstein-Barr virus(EBV) DNA. The main manifestations under endoscopy were multifocal or diffuse irregular ulcers. There was inflammation in the ulcer bases and surrounding areas, where EBV-encoded small RNA (EBER) was positive by in situ hybridization (6/6). The common complications were massive hemorrhage (3/6) and intestinal perforation (2/6). None of treatment agents including glucocorticoid, ganciclovir, foscarnet sodium and cytotoxic drugs was effective. All patients died within 0.5 to 13 months after diagnosis. Conclusions: CAEAE in immunocompetent individuals is a rare disorder with poor prognosis. It is difficult to differentiate CAEAE from inflammatory bowel disease due to similar clinical and endoscopic manifestations.


Assuntos
Enterite/virologia , Infecções por Vírus Epstein-Barr/patologia , Herpesvirus Humano 4 , Úlcera/virologia , Adulto , Enterite/imunologia , Enterite/patologia , Infecções por Vírus Epstein-Barr/imunologia , Feminino , Febre/etiologia , Humanos , Imunocompetência , Hibridização In Situ , Doenças Inflamatórias Intestinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Úlcera/imunologia , Úlcera/patologia
17.
S D Med ; 71(6): 252-255, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30005148

RESUMO

Epstein-Barr virus (EBV) is known to be associated with B-cell lymphoproliferative disorders, and EBV-positive mucocutaneous ulcer (EBV-MCU) is a recently described entity observed in immunocompromised individuals. EBV-MCU is an aggressive appearing ulcerated lesion seen in the skin, oral cavity, and gastrointestinal tract. The process has Hodgkin-like features with a self-limited, indolent course, generally responding well to conservative management. We present a case of EBV-MCU recently encountered in a 54-year-old renal transplant recipient. She had persistent rectal pain and bleeding for over a year following hemorroidectomy. A large ulcer in the distal rectum with excoriation and granular margins was noted on examination, and an initial biopsy from the lesion was inconclusive. A repeat biopsy demonstrated ulcerated squamous and colonic mucosa with a polymorphic lymphoid infiltrate in the submucosa that contained large atypical cells. The large atypical cells were positive for PAX-5 and CD30 and demonstrated EBV RNA by in situ hybridization. EBV-MCU is a recently described occurrence in transplant patients, and awareness of this recently described entity is necessary for appropriate diagnosis and treatment.


Assuntos
Infecções por Vírus Epstein-Barr/diagnóstico , Herpesvirus Humano 4/isolamento & purificação , Úlcera/virologia , Infecções por Vírus Epstein-Barr/patologia , Feminino , Herpesvirus Humano 4/genética , Humanos , Hospedeiro Imunocomprometido , Transplante de Rim , Transtornos Linfoproliferativos/virologia , Pessoa de Meia-Idade , RNA Viral/isolamento & purificação , Úlcera/patologia
18.
Histopathology ; 72(7): 1115-1127, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29314151

RESUMO

AIMS: The aim of the present study was to compare treated lymphoma-associated Epstein-Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) and methotrexate (MTX)-associated EBVMCU. METHODS AND RESULTS: Of a series of 15 Japanese patients (11 women, four men; median age 74 years, range 35-84 years), seven received MTX for the treatment of autoimmune disease and eight developed EBVMCU after treatment of malignant lymphoma [diffuse large B-cell lymphoma (n = 4) without EBV association, adult T-cell leukaemia/lymphoma (n = 2), angioimmunoblastic T-cell lymphoma (n = 1), and follicular lymphoma (n = 1)]. Ulcers were observed in the oral cavity (n = 11), gastrointestinal tract (n = 2), and skin (n = 2). All were histologically characterised by a mixture of EBV-positive large B-cell proliferation and Hodgkin/Reed-Sternberg-like cells on a polymorphous background. A total of 46% (6/13) had monoclonal immunoglobulin heavy chain gene rearrangement, but none had clonal T-cell receptor gene rearrangement. Spontaneous regression occurred in 13 of 15 cases (87%); the other two cases (13%) achieved complete remission after treatment. Of two patients in the treated lymphoma-associated subgroup, one developed multiple new ulcerative lesions on previously unaffected skin, and the other had a relapse of EBVMCU in the oral cavity. No significant clinicopathological differences were found between the subgroups. Notably, none of the patients died from EBVMCU. However, the treated lymphoma-associated subgroup had lower overall survival (P = 0.004) and a shorter follow-up period (P = 0.003) than the MTX-associated subgroup, owing to death from non-associated causes. CONCLUSIONS: Treated lymphoma-associated EBVMCU, which is an indolent and self-limited condition, must be recognised to avoid misdiagnosing it as a relapse of malignant lymphoma during treatment.


Assuntos
Infecções por Vírus Epstein-Barr/etiologia , Imunossupressores/efeitos adversos , Linfoma/complicações , Metotrexato/efeitos adversos , Úlcera/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/tratamento farmacológico , Infecções por Vírus Epstein-Barr/virologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Japão , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Úlcera/virologia
19.
J Cutan Pathol ; 45(2): 162-166, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29086996

RESUMO

Malignant lymphomas presenting in the female genital tract are extremely rare. We report a case of Epstein-Barr virus associated diffuse large B-cell lymphoma of the genital tract and skin in a 60-year-old woman on long-term azathioprine.


Assuntos
Infecções por Vírus Epstein-Barr/complicações , Neoplasias dos Genitais Femininos/patologia , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/virologia , Úlcera/patologia , Feminino , Neoplasias dos Genitais Femininos/virologia , Herpesvirus Humano 4 , Humanos , Pessoa de Meia-Idade , Úlcera/virologia , Vagina/patologia
20.
Gastroenterol Hepatol ; 41(1): 40-42, 2018 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27998629
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