Avoid common mistakes on your manuscript.
To the Editors,
We report a 12-year-old Chinese boy diagnosed with Crohn’s disease according to the European Society of Pediatric Gastroenterology, Hepatology and Nutrition Revised Porto Criteria (Fig. 1) [1], who was diagnosed with Epstein–Barr virus (EBV) encephalitis after prior treatments with 6-mercaptopurine and infliximab. Initial symptoms included headache, vomiting, and convulsions accompanied by a low-grade fever. EBV-DNA in cerebrospinal fluid and Early Antigen (EA)-IgG in serum were positive (Fig. 2). Based on his symptoms and laboratory evaluation, he was diagnosed with EBV encephalitis and fully recovered after supportive treatment. This case illustrates that pediatric CD patients who have received immunosuppressants and biologic therapy may be susceptible to severe complications of viral infections, including EBV encephalitis [2]. Whether immunosuppressants and biologics facilitate EBV delivery across the blood–brain barrier remains unknown.
A–C Representative endoscopy photograph of the lesion in colon. D Representative capsule endoscopy photograph of the lesion in small intestine. E Representative enhanced computed tomographic (CT) scan of the gut. F Biopsy showing ulcer and chronic inflammation
A Expression levels of serum EA-IgM, NA-IgG, VCA-IgG, VCA-IgM, EA-IgG from the patient at different time points. CD Crohn’s disease, EBV Epstein–Barr virus, EA-IgM anti-early antigen immunoglobulin M, NA-IgG anti-viral nuclear antigen immunoglobulin G, VCA-IgG anti-viral capsid antigen immunoglobulin G, VCA-IgM anti-viral capsid antigen immunoglobulin M, EA-IgG anti-early antigen immunoglobulin G. B Amplification curve of reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) reaction targeting the EBV DNA in cerebrospinal fluid samples. The number of cycles (Ct) was 32.11 and EBV DNA was 2.13 × 103 copies/ml. C Representative magnetic resonance imaging (MRI) of the brain. D Schematic illustration for the treatment of the patient before EBV encephalitis
References
Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, Kolho KL, Veres G, Russell RK, Paerregaard A, Buderus S, Greer ML, Dias JA, Veereman-Wauters G, Lionetti P, Sladek M, Martin de Carpi J, Staiano A, Ruemmele FM, Wilson DC. European Society of Pediatric Gastroenterology, Nutrition. ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2014;58:795–806. https://doi.org/10.1097/MPG.0000000000000239
Ali T, Yun L, Shapiro D, Madhoun MF, Bronze M. Viral infections in patients with inflammatory bowel disease on immunosuppressants. Am J Med Sci. 2012;343:227–232. https://doi.org/10.1097/MAJ.0b013e31821ff728
Funding
This work received support from key research and development projects of Zhejiang Science and Technology Department (Grant No. 2019C03037) and Zhejiang Natural Science Foundation (Grant No. LQ22H160006).
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
About this article
Cite this article
Yu, J., Lv, Y., Luo, Y. et al. One Case of Epstein–Barr Virus Encephalitis from Pediatric Crohn’s Disease After 6-Mercaptopurine and Infliximab Treatment. Dig Dis Sci 68, 1653–1655 (2023). https://doi.org/10.1007/s10620-022-07801-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-022-07801-4