Chronic active Epstein‒Barr virus colitis, a rare cause of recurrent diarrhea in an immunocompetent female: a case report.

backgroundChronic active Epstein-Barr virus (CAEBV) colitis is a rare disease with clinical and endoscopic manifestations very similar to those of inflammatory bowel disease (IBD). In clinical practice, it is easy to be misdiagnosed and mistreated, leading to poor clinical outcomes. CASE PRESENTATION: We report a case of a 56-year-old Chinese woman who presented with 6 years of intermittent severe diarrhea, fever, and abdominal pain. Ulcerative colitis was initially suspected. The patient's clinical symptoms were partially relieved after treatment with mesalazine and probiotics. However, the symptoms were repeated and improved after supportive and symptomatic treatment each time. Colonoscopy revealed multiple mucosal erosion and edema in the colon, EBV-encoded small RNA 1/2 in situ hybridization in the pathological tissue of the colon was positive (20/HP), and EBVDNA in the peripheral blood was positive. CAEBV colitis was diagnosed. The patient was given dexamethasone and acyclovir, and she was improved after treatment. Unfortunately, she was discharged without outpatient follow-up, and similar symptoms recurred one year later, with similar colonoscopy and pathological examinations. Symptoms were relieved after dexamethasone treatment.

conclusionThis case highlights the diagnostic challenges posed by nonspecific clinical manifestations of CAEBV colitis, which should be included as a differential diagnosis in patients with recurrent diarrhea and fever to avoid misdiagnosis.