P669. Inflammatory bowel disease and Epstein–Barr virus: analysis of our experience
Á. Araujo Míguez, C. Trigo Salado, J.L. Márquez Galán, M.D. De la Cruz Ramírez, J.M. Herrera Justiniano, E. Leo Carnerero, Hospital Universitario Virgen del Rocío, Gastroenterology, Seville, Spain
Infection by the Epstein–Barr virus (EBV) has been related to inflammatory bowel disease (IBD), but its implication in pathogenesis or exacerbation of the disease is uncertain. Its role in development of lymphoproliferative syndromes associated to immunosuppression is however well known, mainly in transplant patients and in IBD since introduction of thiopurines.
Our objective was to report the association of immunosuppression and EBV as risk factors for the lymphoproliferative syndrome, including the lymphoplasmacytic infiltrate that may precede development of lymphoma.
A retrospective study of patients with IBD in which histology showed a polytypic lymphoplasmacytic infiltrate (lambda and kappa chains) or lymphoma associated to EBV between December 2010 and October 2013.
General patient and IBD characteristics, prior treatments, histological findings at the time of diagnosis of EBV infection, and subsequent course were recorded.
Presence of EBV was tested using EBER probe hybridization with the respective messenger RNA.
13 patients with IBD with a mean disease duration since diagnosis of 125.46±84.94 months were enrolled. 7 patients (53.8%) were male, and mean age was 40.46±9.98 years. As regards type of IBD, 7/13 (53.8%) had Crohn's disease (CD), 5/13 (38.5%) ulcerative colitis (UC), and 1/13 (7.7%) non-classifiable IBD. In 11 patients, histology revealed polytypic lymphoplasmacytic infiltrate associated to EBV with no evidence of malignancy, and lymphoma associated to EBV was found in two patients.
At diagnosis, patients were being treated with corticosteroids (7/13, 53.8%), azathioprine (5/13, 38.5%), and biologics (7/13, 53.8%). Another two patients had taken azathioprine before diagnosis. Mean time of treatment with azathioprine was 75.15±34.9 months. Mean duration of treatment with azathioprine was 75.14±34.85 months. All patients were in the exacerbation phase of IBD.
None of the 11 patients developed lymphoma from the polytypic lymphoplasmacytic infiltrate associated to EBV after a mean follow-up (months) of 18±7.5 despite use of immunosuppressants and/or biologics in 8/13 (72.73%) of them.
A lymphoplasmacytic infiltrate associated to EBV is a histological finding of uncertain significance made in a subgroup of patients with long-standing IBD, severe inflammatory activity, and chronic use of immunosuppressant and/or biologic drugs. Its implication in sequential development of lymphoproliferative syndromes and follow-up measures to be taken are not clear.
Because of the increased incidence of lymphoma and its association to EBV since the introduction of thiopurines, we think that, based on these findings, longer follow-up with colonoscopy should be performed to assess changes in the lesion over time.