title: Chronic active Epstein-Barr virus infection mimicking autoimmune hepatitis exacerbation in a patient with systemic lupus erythematosus.
abstract: Chronic active Epstein-Barr virus infection (CAEBV) is characterized by chronic infectious mononucleosis-like symptoms. We report a very rare case with autoimmune hepatitis (AIH) complicated by CAEBV. A 50-year-old woman with systemic lupus erythematosus (SLE) complicated by AIH began to suffer from acute respiratory failure and her clinical symptoms improved rapidly in response to steroid treatment. However, during the gradual tapering of the steroid dose, a steady increase of the serum hepatobiliary enzyme levels subsequently was observed and the patient began to have continuous fever. Moreover, upper gastrointestinal endoscopy revealed multiple intractable gastric ulcers. When EBER-ISH was performed on liver biopsy and gastric mucosal biopsy specimens, EBER-positive lymphocytes were observed. When peripheral blood was examined, 2.1 × 10(6) copies/µg of EBV-DNA were observed in the CD4-positive T cells, confirming the diagnosis of CAEBV. A cooling therapy was started by steroid and cyclosporine. Thereafter, despite the start of CHOP therapy, she developed a malignant lymphoma (PTCL-NOS) and died of hepatic failure. When treatment-resistant AIH patients are encountered, not only AIH exacerbation but also CAEBV should be considered in the differential diagnosis.
authors.affiliation: Division of Rheumatic Diseases, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan hiroyuki_yjp2005@yahoo.co.jp.
authors.forename: H
authors.initials: H
authors.lastname: Yamashita
authors.affiliation: Division of Rheumatic Diseases, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Division of Rheumatic Diseases, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tsuchiya
authors.affiliation: Division of Rheumatic Diseases, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Division of Rheumatic Diseases, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kaneko
authors.affiliation: Division of Rheumatic Diseases, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kano
authors.affiliation: Division of Rheumatic Diseases, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Mimori
mesh_terms: D002908:Chronic Disease; D003937:Diagnosis, Differential; D018450:Disease Progression; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D019693:Hepatitis, Autoimmune / Q000175:diagnosis*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged
keywords: Autoimmune hepatitis (AIH); chronic active Epstein-Barr virus infection (CAEBV); gastric ulcers; interstitial pneumonia; systematic lupus erythematosus