Multiple Intestinal Ulcers Associated with Primary Epstein-Barr Virus Infection in a Patient with Rheumatoid Arthritis Undergoing Methotrexate Therapy

Yuichi Makino; Chikayoshi Tani; Naoyuki Miyokawa; Ryota Yoshimoto; Katsutoshi Mizumoto; Kohei Eguchi; Daisuke Fujishiro; Satoru Kodama; Atsushi Kobayashi; Keiji Komura; Kensaku Okamoto; Hiroyuki Furukawa; Masakazu Haneda

doi:10.2169/internalmedicine.54.4735

CASE REPORTS

Multiple Intestinal Ulcers Associated with Primary Epstein-Barr Virus Infection in a Patient with Rheumatoid Arthritis Undergoing Methotrexate Therapy

Yuichi Makino, Chikayoshi Tani, Naoyuki Miyokawa, Ryota Yoshimoto, Katsutoshi Mizumoto, Kohei Eguchi, Daisuke Fujishiro, Satoru Kodama, Atsushi Kobayashi, Keiji Komura, Kensaku Okamoto, Hiroyuki Furukawa, Masakazu Haneda

Author information

Yuichi Makino
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan
Chikayoshi Tani
Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical University, Japan
Naoyuki Miyokawa
Department of Surgical Pathology, Asahikawa Medical University, Japan
Ryota Yoshimoto
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan
Katsutoshi Mizumoto
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan
Kohei Eguchi
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan
Daisuke Fujishiro
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan
Satoru Kodama
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan
Atsushi Kobayashi
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan
Keiji Komura
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan
Kensaku Okamoto
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan
Hiroyuki Furukawa
Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical University, Japan
Masakazu Haneda
Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan

Keywords: Epstein-Barr virus, intestinal ulcer, methotrexate, rheumatoid arthritis

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 22 Pages 2851-2855

DOI https://doi.org/10.2169/internalmedicine.54.4735

Details

Abstract

A 47-year-old woman with a 2-year history of rheumatoid arthritis (RA) undergoing methotrexate treatment developed a perforated ulcer in the ileum for which she underwent emergency surgery. A histological analysis of the extirpated specimen presented a possible Epstein-Barr virus (EBV) infection in the ulcerative lesion without a feature of lymphoproliferative disorder. Interestingly, the patient's serological tests with a paired serum diagnosed a primary EBV infection. The present case emphasizes the importance of being aware of severe enteritis as a possibility for patients with RA, for an accurate diagnosis.

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