Si-Zhu Wang1,2, Ying-Huan Dai3, Jie Zhang4,5, Fang-Gen Lu1,2, La-Mei Yan1,2, Shan Wu1,2. 1. Department of Gastroenterology, The Second Xiangya Hospital, Changsha, 410011, Hunan, China. 2. Research Center of Digestive Disease, Central South University, Changsha, 410011, Hunan, China. 3. Department of Pathology, The Second Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China. 4. Department of Gastroenterology, The Second Xiangya Hospital, Changsha, 410011, Hunan, China. jiezhang@csu.edu.cn. 5. Research Center of Digestive Disease, Central South University, Changsha, 410011, Hunan, China. jiezhang@csu.edu.cn.
Abstract
BACKGROUND: Epstein-Barr virus (EBV)-associated NK/T-cell lymphoproliferative disorder (LPD) involving the gastrointestinal tract is rarely observed in individuals with normal immunity. The atypical clinical, colonoscopic manifestations often confuse clinicians, leading to misdiagnosis and delays in the treatment. CASE PRESENTATION: Herein, we reported on a single case of a patient with gastrointestinal symptoms. Several colonoscopies showed multiple irregular ulcerations, while biopsies showed colitis with infiltration of neutrophils or lymphocytes. After 2 months follow-up, the patient was diagnosed with the extranodal NK/T-cell lymphoma, nasal type, and was treated with thalidomide. Later on, a second check was performed on his first pathological sample. Immunohistochemistry revealed EBV associated NK/T-cell LPD. CONCLUSIONS: Multiple, multiform, and segmental gastrointestinal ulcers should be an indication for EBV infection, regardless of the presence of fever, lymphadenopathy, and hepatosplenomegaly. If EBV-associated NK/T-cell LPD is considered, serum EBV-DNA should be measured, and the tissue obtained by biopsy should be carefully analyzed for a positive expression of the EBER marker.
BACKGROUND:Epstein-Barr virus (EBV)-associated NK/T-cell lymphoproliferative disorder (LPD) involving the gastrointestinal tract is rarely observed in individuals with normal immunity. The atypical clinical, colonoscopic manifestations often confuse clinicians, leading to misdiagnosis and delays in the treatment. CASE PRESENTATION: Herein, we reported on a single case of a patient with gastrointestinal symptoms. Several colonoscopies showed multiple irregular ulcerations, while biopsies showed colitis with infiltration of neutrophils or lymphocytes. After 2 months follow-up, the patient was diagnosed with the extranodal NK/T-cell lymphoma, nasal type, and was treated with thalidomide. Later on, a second check was performed on his first pathological sample. Immunohistochemistry revealed EBV associated NK/T-cell LPD. CONCLUSIONS: Multiple, multiform, and segmental gastrointestinal ulcers should be an indication for EBV infection, regardless of the presence of fever, lymphadenopathy, and hepatosplenomegaly. If EBV-associated NK/T-cell LPD is considered, serum EBV-DNA should be measured, and the tissue obtained by biopsy should be carefully analyzed for a positive expression of the EBER marker.
Authors: S Sazuka; Y Takahashi; T Kawaguchi; T Sato; T Nakagawa; Y Furuya; M Saito; K Saito; T Katsuno; C Nakaseko; O Yokosuka Journal: Endoscopy Date: 2012-03-06 Impact factor: 10.093