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P507. EBV serology status and azathioprine-associated complications: a single centre study

P. Sousa, P. Ministro, D. Martins, E. Cancela, J. Machado, A. Silva, Centro Hospitalar Tondela-Viseu, Gastroenterology, Viseu, Portugal

Background

Inflammatory bowel disease (IBD) treatment frequently involves the use of immunosuppressants. There have been some reports of complications in both Epstein–Barr virus (EBV) seropositive and seronegative patients who acquire a primary EBV infection, namely lymphoproliferative disorders and haemophagocytic lymphohistiocytosis (HLH). Our aim was to examine the status of EBV serology in IBD patients followed in our centre, and to report the complications associated with the use of azathioprine (AZA) and EBV in these patients.

Methods

All IBD patients in our institution with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC), electronic medical records and a record of EBV serology (IgM and IgG) were retrospectively identified. The concomitant use of AZA and EBV-associated complications were analysed.

Results

From a database of 307 patients (156 with CD and 151 with UC) we identified 86 patients with a record of EBV serology (61 with CD and 25 with UC). All UC patients were EBV-positive, indicating previous infection. In the CD group, 54 patients were EBV-positive, 3 male patients with ages 18, 19 and 45 were EBV-negative, 2 patients were positive for both EBV IgG and IgM and 2 patients were positive for IgG and had an inconclusive IgM. Among patients over the age of 26 only one was EBV-negative (∼2%).

Seventy-three percent of patients (53 patients with CD and 10 patients with UC) were medicated with AZA, with a mean time of exposure of 29 months/patient. All 3 of CD patients who were seronegative were placed on AZA. In one of them AZA was suspended after 8 months due to lack of response. Other patient stopped attending IBD appointments some months after initiation of AZA. He decided to cease the medication after 3 years and later developed mononucleosis syndrome. The last patient has been medicated with AZA and infliximab for 6 months now. There were no records of major EBV-associated complications in any patient.

Conclusion

In this study, most of IBD patients were EBV-positive. The vast majority of patients over the age of 26 (>98%) were EBV-positive. We didn't find any EBV-associated complication in either seronegative or seropositive patients medicated with AZA. Nevertheless, EBV is reported to be associated with several malignancies such as lymphomas and HLH. With this study we can't conclude about safety of AZA according to EBV serology status due to the small number of EBV-negative patients. Other considerations such as EBV viral load could have an important role in reactivation and complications in EBV-positive patients. Concerning EBV-negative patients clinicians should have a low threshold for evaluation in case of any suspicion of EBV infection and appropriate therapy should be immediately started.