Donor-derived Epstein-Barr Virus Mucocutaneous Ulceration: A Unique and Complex Case of Rectal Hemorrhage.

Abstract

E pstein-Barr virus (EBV) is pervasive, with a significant proportion of humans being asymptomatic carriers. Latent infection risk is an issue in the immunosuppressed because of the exerted effects of expressed viral proteins on B-lymphocyte maturation and proliferation or because of T-lymphocyte reaction. 1,2 This interaction produces a spectrum of lymphoproliferative disorders that includes EBV-mucocutaneous ulcer (MCU), in which the most severe disease process on the spectrum is posttransplant lymphoproliferative disorder (PTLD). 3 EBV-MCU is separate from PTLD, because of its indolent clinical course, without its progression to disseminated disease, and despite a significant degree of cytological atypia seen histologically. 4 Although it may not disseminate, it can be locally destructive and, in the case we discuss here, is the only EBV-MCU in the literature in the rectal mucosa to pre-sent with rectal hemorrhage. Hemorrhage in a young post-transplant patient is difficult to manage, given reluctance for multiple sensitizing blood transfusions, especially if, as in this case, they are reliant on anticoagulation.