Substantial Epstein-Barr virus reactivation in a case of severe refractory ulcerative colitis: a possible role in exacerbation
Substantial Epstein-Barr virus reactivation in a case of severe refractory ulcerative colitis: a possible role in exacerbation
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严重难治性溃疡性结肠炎病例中大量 Epstein-Barr 病毒重新激活：可能导致病情恶化
DOI：
10.1007/s12328-020-01319-w
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发表时间：
2021
影响因子：
1
通讯作者：
Yusuke Kinugasa & Ma
中科院分区：
文献类型：
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作者：
Shu Kato;Hiromichi Shimizu;Shohei Tomii;Hitoshi Uchida;Ami Kawamoto;Shuji Hibiya;Maiko Motobayashi;Kento Takenaka;Toshimitsu Fujii;Eiko Saito;Masakazu Nagahori;Kazuo Ohtsuka;Mariko Negi;Takumi Akashi;Takatoshi Matsuyama;Yusuke Kinugasa & Ma
溃疡性结肠炎 (UC) 是一种炎症性肠病，会导致结肠慢性炎症。 5-氨基水杨酸和免疫抑制药物（例如皮质类固醇、免疫调节剂和生物制剂）用于治疗这些患者。然而，接受免疫抑制药物的 UC 患者可能面临某些机会性感染的风险。 EB病毒（EBV）是机会性感染之一，其致病作用已被证实与难治性UC有关，但其致病性有待进一步研究。在这里，我们报告了一个难治性 UC 的手术病例，该病例在入院时表现出 EBV 血清学后感染模式，但后来在外周血和结肠粘膜中出现高 EBV 载量。这些发现表明，EBV 可能在结肠中重新激活，之后它损害了这位 UC 患者的结肠粘膜并加剧了炎症。因此，EBV 可能会导致严重的皮质类固醇和抗 TNFα 药物的难治性反应，从而需要紧急手术。对难治性 UC 患者进行 EBV 病毒监测可能有助于了解患者的病理生理学并预测对药物的反应，并且为这些患者开发抗病毒干预措施可能会改善其预后。
Ulcerative colitis (UC) is an inflammatory bowel disease that causes chronic inflammation in the colon. 5-aminosalicylic acid and immunosuppressive medications such as corticosteroids, immunomodulators, and biologic agents are used to treat these patients. However, patients with UC who receive immunosuppressive medications may be at risk for certain opportunistic infections. Epstein–Barr virus (EBV) is one of those opportunistic infections, and its pathogenic role has been implicated in refractory UC, but its pathogenicity should be further investigated. Here, we report a surgical case of refractory UC that demonstrated a serologically post-infected pattern of EBV at admission but that later had a high load of EBV in both the peripheral blood and colonic mucosa. These findings suggest that EBV may have been reactivated in the colon, after which it damaged the colonic mucosa and aggravated inflammation in this patient with UC. Thus, EBV might lead to severity and a refractory response against corticosteroids and anti-TNFα agents, necessitating emergency surgery. Viral surveillance for EBV in patients with refractory UC may facilitate understanding of the patient’s pathophysiology and predicting response to medications, and the development of antiviral intervention for those patients may improve their prognosis.