Extended-release Multimatrix Budesonide for Microscopic Colitis.

ogists found a small lymphoproliferative lesion (Fig. 2B) in the rectum biopsy with an immunohistochemistry result of CD7++, CD202, and EBV-encoded small RNA+. To exclude the diagnosis of lymphoma, we reexamined the colonoscopy and took 32 pieces of biopsies. None of the biopsies showed even a LPD change. He was diagnosed with EBV-associated enteritis accompanied with EBV-associated LPD. We speculate that CAEAE can turn into LPD, which is a precancerous condition to lymphoma4,5 (Fig. 2). Chronic active EBV infection is a rare disorder, especially in gastrointestinal tract, which usually takes the form of LPD rather than a simple inflammation. There are only 3 cases of EBV-infected enteritis with no involvement of an underlying LPD in immunocompetent adult reported in the English literature worldwide till now.6–8 The patients all recovered from supportive treatment and the long-term follow-ups are unknown. We believe this to be the first reported case of CAEAE in an immunocompetent adult. The prognosis of CAEAE is unknown. We know that LPD is a precancerous condition5 and we have reported a case with LPD developed into lymphoma.4 From this case, we know that CAEAE would turn into LPD one day and should be monitored closely. EBV-associated colitis is hard but important to distinguish from IBD. IBD is associated with a higher prevalence of opportunistic infections, including EBV infections, for the damaged intestinal immune barrier or on immunosuppressive medications.3 The thiopurine therapy would impair the T cell activity, and thus decreased immunosurveillance of latent EBV infection and facilitate the reactivation EBV. EBV infection will cause relapses or deteriorations in patients with IBD. Before making a diagnosis of IBD, we should rule out all the infected diseases including EBV infection. In this case, the patient was diagnosed with UC after consultations, through the acute and short course, enlarged spleen and enlarged cervical lymph nodes during the relapse could not match UC well. The pathologists found cryptitis and crypt abscess with a complete mucosal structure in the slides. But cryptitis and crypt abscess not only exist in UC but also in some virusinfected enteritis. The diagnosis of CAEAC should be supported by medical history and pathological findings. In conclusion, the diagnosis of CAEAE should be supported by medical history and pathological findings. EBV infection in intestinal can also cause a recurrent infection in an immunocompetent individual and develop into LPD someday. So CAEAE should be monitored closely for it is a precancerous disease. Our patient has been free of symptoms since the last discharge and he is very closely followed.