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Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
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EBV colitis with ulcerative colitis: a double whammy.

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A young man with ulcerative colitis (UC) developed a superimposed Epstein-Barr virus (EBV) colitis. Prompt diagnosis and treatment with ganciclovir led to recovery, highlighting the need to consider co-infections in refractory IBD cases.

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Area of Science:

  • Gastroenterology
  • Virology
  • Immunology

Background:

  • Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD).
  • Immunocompetent individuals can experience complex gastrointestinal infections.
  • Epstein-Barr virus (EBV) can cause various clinical manifestations.

Observation:

  • A 21-year-old immunocompetent male presented with symptoms suggestive of active UC.
  • Initial treatment with intravenous steroids for UC did not resolve symptoms or lower inflammatory markers.
  • A virology screen revealed prior EBV infection, prompting suspicion of superimposed EBV colitis.

Findings:

  • Endoscopic and histological findings confirmed UC.
  • EBV DNA PCR on colonic biopsies was positive, confirming EBV colitis.
  • The patient responded well to intravenous ganciclovir therapy.

Implications:

  • This case underscores the importance of suspecting superimposed infections in IBD patients with poor response to standard immunosuppressive therapy.
  • Considering viral co-infections like EBV is crucial for effective management of refractory IBD.
  • Timely diagnosis and targeted antiviral treatment can significantly improve outcomes in such complex cases.