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Chronic active EBV infection with features of granulomatosis with polyangiitis
Author(s) -
Shimomura Masaki,
Morishita Hideaki,
Meguro Takaaki,
Seto Shiro,
Kimura Mitsuaki,
Hamazaki Minoru,
Hashimoto Ayako,
Sugiyama Yuka,
Kimura Hiroshi
Publication year - 2016
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.12892
Subject(s) - medicine , pathological , granulomatosis with polyangiitis , microscopic polyangiitis , vasculitis , histology , chronic sinusitis , pathology , differential diagnosis , immunology , sarcoidosis , sinusitis , disease
Herein, we report the case of a 13‐year‐old boy with multiple recurrent ulcers on his legs. He developed severe sinusitis at 10 years of age and had significant weight loss (6 kg) in the 2 months prior to admission. Histology of tissue biopsied from the ulcer indicated small vessel vasculitis and granulomatous inflammation. Given that these findings met the diagnostic criteria for granulomatosis with polyangiitis (GPA), he was treated with immunosuppressive agents. Further pathology, however, indicated Epstein–Barr virus (EBV)‐encoded RNA (EBER) in most lymphocytes in the same sample. The EBER‐positive lymphocytes were mainly CD4‐positive T cells. The EBV‐DNA load in the peripheral blood was also abnormally increased (1.0 × 10 4 copies/μg DNA). Thus, the diagnosis was established as chronic active EBV infection (CAEBV). This case illustrates the necessity of careful differential diagnosis of CAEBV owing to its clinical resemblance and pathological overlap with GPA.