title: Epstein-Barr virus-associated enteritis with multiple ulcers after stem cell transplantation: first histologically confirmed case.
abstract: The present case involves unique enteritis forming multiple ulcers associated with Epstein-Barr virus (EBV). A 57-year-old man had undergone a reduced intensity allogeneic stem cell transplantation for a relapse of multiple myeloma following sequential autologous peripheral blood stem cell transplantation. The ileum, resected for massive melena, showed multiple irregular ulcers with occasional cobblestone-like appearance. There was inflammation including numerous plasma cells in the ulcer bases and surrounding areas, where many EBV-infected plasma cells were detected by double staining with EBV-encoded small RNA-1 (EBER-1) in situ hybridization and CD79a, while EBV-infected epithelial cells were not noted. The number of EBER-1-positive cells in the ileum (mucosa, 1451 cells/mm(2); submucosa, 465 cells/mm(2)) was much larger than in control samples (malignant lymphoma or leukemia after allogeneic stem cell transplantation, n = 4, range 0-113 cells/mm(2); malignant lymphoma after chemotherapy, n = 14, range 0-0.89 cells/mm(2); colon cancer, n = 12, range 0-3.5 cells/mm(2)). In the mucosa near the ulcers, EBER-1-positive cells often surrounded and involved the glandular epithelium, forming lymphoepithelial-like lesions. The histological findings differ from post-transplant lymphoproliferative disorders or intestinal thrombotic microangiopathy, and this is the first case of EBV-associated enteritis with ulcers characterized by numerous plasma cells and lymphoepithelial-like lesions after stem cell transplantation.
authors.affiliation: Department of Pathology, Imakiire General Hospital, Japan.
authors.forename: Yukie
authors.initials: Y
authors.lastname: Tashiro
authors.forename: Masamichi
authors.initials: M
authors.lastname: Goto
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Takemoto
authors.forename: Eiichi
authors.initials: E
authors.lastname: Sato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shirahama
authors.forename: Atae
authors.initials: A
authors.lastname: Utsunomiya
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Eizuru
authors.forename: Suguru
authors.initials: S
authors.lastname: Yonezawa
mesh_terms: D051925:CD79 Antigens / Q000378:metabolism; D004751:Enteritis / Q000276:immunology / Q000473:pathology / Q000821:virology*; D020031:Epstein-Barr Virus Infections / Q000276:immunology / Q000473:pathology*; D006086:Graft vs Host Disease / Q000517:prevention & control; D004854:Herpesvirus 4, Human; D006801:Humans; D007082:Ileum / Q000276:immunology / Q000473:pathology* / Q000821:virology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017403:In Situ Hybridization; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy; D010950:Plasma Cells / Q000276:immunology; D012367:RNA, Viral / Q000378:metabolism; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014456:Ulcer / Q000276:immunology / Q000473:pathology / Q000821:virology*
chemical_list: D051925:CD79 Antigens; C099537:Epstein-Barr virus encoded RNA 1; D007166:Immunosuppressive Agents; D012367:RNA, Viral