EBVMCU in a liver-transplant patient

Area of Science:

• Gastroenterology
• Transplant Surgery
• Infectious Diseases

Background:

• Post-liver transplant patients often require long-term immunosuppression to prevent organ rejection.
• Immunosuppressive medications can increase the risk of opportunistic infections and viral reactivation.
• Maintaining a delicate balance between immunosuppression and infection prevention is crucial for patient outcomes.

Observation:

• A 36-year-old male liver transplant recipient presented with a two-month history of diarrhea, weakness, and appetite loss.
• Initial investigations revealed iron-deficiency anemia, lymphopenia, and elevated C-reactive protein, with negative blood/stool cultures and CMV testing.
• Colonoscopy identified two fimbriated rectal ulcers near the anal sphincter.

Findings:

• Biopsies from the rectal ulcer margins confirmed the presence of Epstein-Barr virus (EBV).
• The patient's symptoms resolved completely within three weeks of reducing immunosuppressive medication.
• Follow-up colonoscopy showed complete healing of the rectal ulcers.

Implications:

• This case highlights Epstein-Barr virus (EBV) as a potential cause of ulcerative proctitis in immunosuppressed transplant recipients.
• Diminishing immunosuppression can be an effective strategy for managing EBV-associated gastrointestinal complications.
• Close monitoring for opportunistic infections is essential in patients undergoing long-term immunosuppressive therapy after organ transplantation.