Fatal Epstein-Barr Virus Primo Infection in a 25-Year-Old Man Treated with Azathioprine for Crohn's Disease

Abstract

We report a case of Epstein-Barr virus (EBV) primo infection with the development of successive infectious mononucleosis, hemophagocytic lymphohistiocytosis, and B-cell lymphoproliferative disorder in a patient treated with azathioprine for Crohn's disease. This case report suggests that specific EBV-related clinical and virological management should be considered when treating a patient with inflammatory bowel disease with azathioprine.

A case of a girl presenting with fever, cytopenia, liver dysfunction, hepatosplenomegaly, and hemophagocytosis in the bone marrow

“…3,8,9,12,13 Rituximab is a humanized anti-CD20 monoclonal antibody which targets and depletes mature B cells within 48 h of therapy. In relation to HLH, the inclusion of rituximab may rapidly reduce the numbers of B cells containing EBV; it is these cells that are thought to drive the dysregulation of the inflammatory response.…”

“…Recently patients treated with azathioprine for Crohn's disease have also been found to be at risk. [3][4][5][6][7] In addition to HLH, the differential should also include various malignancies, including leukaemia, infections and rheumatoid disorders.…”

Hemophagocytic lymphohistiocytosis in Crohnʼs disease associated with primary infection by Epstein–Barr virus

“…While most infections are due to EBV and cytomegalovirus (CMV), other cases have been published caused by tuberculosis and histoplasmosis. With regard to EBV infection in IBD, there are four cases [5][6][7][8] described to date, all primoinfections in immunosuppressed patients with high mortality (75%). Of the three out of four patients who died, two of these did not receive therapy with etoposide and the other died despite it.…”

Epstein–Barr Virus and Parvovirus B19 Coinfection in a Crohnʼs Disease Patient Under Azathioprine

“…In the literature, we found reports of 7 cases of infectious mononucleosis in patients with CD under treatment with azathioprine. [3][4][5][6] Three of these infections were fatal, all of them developed a rare condition, hemophagocytic syndrome, characterized by high fever, cytopenias, hepatosplenomegaly, liver function and coagulation abnormalities. There has recently been a report in the literature of an acute parvovirus B19 infection inducing severe leukopenia in CD under azathioprine.…”