Chronic active EBV infection with GI involvement tied to poor prognosis

A recent study has found a low incidence of chronic active Epstein‒Barr virus infection (EBV) with gastrointestinal (GI) involvement, with colon being the most common location of involvement.

Chronic active EVB patients with GI involvement normally have a poor prognosis, and those with high shole blood EBV-DNA copy levels early in their illness are vulnerable to developing GI involvement.

A team of researchers conducted an observational study including all paediatric chronic active EBV patients treated at Beijing Children’s Hospital from June 2017 to June 2021. They divided the patients into case and control groups according to whether patients had GI involvement. The researchers then observed clinical manifestations, laboratory and ultrasound examinations, treatment, and prognosis.

Of the 72 patients enrolled in the study, 15 (20.8 percent) had GI involvement, with a median onset age of 3.71 years. Diarrhoea was the most common clinical manifestation at onset (13/15).

On GI ultrasound, the researchers found pneumatosis intestinalis, mild-to-moderate swelling of the surrounding mesentery and omentum, as well as enhancement. Endoscopic features observed were hyperaemia, oedema, and ulcers of variable morphological characteristics.

Furthermore, pathological examination revealed lymphocyte infiltration with EBV-encoded small RNA. The usual location of GI involvement were the colon (n=6) and gastric antrum (n=3).

Over a median follow-up of 13.26 months, 10 patients survived and five died, including one caused by intestinal perforation due to necrotizing enterocolitis.

The case group showed higher alanine aminotransferase levels (p=0.038), aspartate aminotransferase (p=0.040), and whole blood EBV-DNA copies (p<0.001) and lower natural killer cell activity (p<0.001) compared with the control group. Overall survival rate of the case group at 3 years was significantly lower than that of the control group (59.3 percent vs 79.4 percent; p=0.021).

“Chronic active EBV is an intractable and progressive disease. T cells or NK cells infected by EBV can proliferate and infiltrate into multiple organs,” the researchers said.

”Chronic active EBV combined with GI involvement is a rare clinical disease that has not been well described, and sometimes it may clinically mimic gastroenteritis or inflammatory bowel disease,” they added.