title: Acute Epstein-Barr virus infection presenting as severe gastroenteritis without infectious mononucleosis-like manifestations.
abstract: Primary Epstein-Barr virus (EBV) infection is usually a self-limiting disease. Although it is sometimes accompanied by severe complications such as thrombocytopenia, hemolytic anemia, and splenic rupture, predominantly gastrointestinal complications are rarely reported. We studied an unusual case of primary EBV infection associated with severe hemorrhagic gastroenteritis. EBV infection was confirmed in the biopsy specimen by demonstrating the presence of EBV DNA by polymerase chain reaction, and of EBV-encoded small RNA (EBER)-positive cells by in-situ hybridization. Our patient was suspected of having primary EBV infection from the serological findings-EBV-viral capsid antigen IgM (+) and EBV nuclear antigen (-)-but he did not show typical clinical features of infectious mononucleosis such as lymph node swelling, pharyngitis, liver dysfunction, and splenomegaly. A definite diagnosis of primary EBV infection was made using biopsy specimens by demonstrating the presence of EBV DNA and EBER-positive cells.
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Fujiwara
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan. shmiyamo@kuhp.kyoto-u.ac.jp.
authors.forename: Shin'ichi
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Kouta
authors.initials: K
authors.lastname: Iguchi
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Matsunaka
authors.affiliation: Laboratory of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sakashita
authors.affiliation: Laboratory of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Tsuruyama
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, Toyama University, Toyama, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kanegane
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Marusawa
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakase
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Chiba
keywords: EBV-encoded early small RNA; Epstein–Barr virus; Gastroenteritis; Polymerase chain reaction