Epstein-Barr Virus Infection Presenting With Acute Gastrointestinal Involvement. Report of Two Cases of Epstein-Barr Virus Colitis in Kidney-Transplant Recipients and Scoping Review of the Literature

Abstract

Epstein-Barr virus (EBV) is a herpesvirus capable of establishing lifelong latent infections, leading to a wide spectrum of diseases. It can affect multiple organs, including the gastrointestinal tract, typically through lymphoproliferative syndromes or gastric cancer, while acute gastrointestinal disease is rare and poorly understood. Two cases of EBV-induced acute colitis in kidney transplant recipients were described. Additionally, a scoping review of the literature was conducted to identify all reported cases of EBV infection presenting with acute gastrointestinal involvement. A total of 11 174 articles from PubMed and Embase were analyzed, from which 30 articles were ultimately selected, encompassing 33 cases. Two distinct patient profiles emerged. Patients with gastric-limited disease were typically healthy women and exhibited a benign course, characterized by a more acute presentation and complete recovery in all cases. In contrast, patients with intestinal disease were often immunocompromised, presenting with deep colonic ulcers frequently associated with rectal bleeding, high rates of perforation, frequent need for surgical intervention, and significant mortality. Antiviral therapy and reduction of immunosuppression were commonly employed, although no specific treatment approach demonstrated a clear benefit in reducing mortality or complications. In conclusion, EBV-related gastrointestinal disease varies by patient immunocompetence and the site of involvement. Gastric-limited disease usually has a favorable prognosis, while intestinal involvement in immunocompromised patients is linked to severe complications and higher mortality. Individualized treatment strategies and vigilant long-term follow-up are needed due to the lack of standardized treatment protocols and the risk of relapse or development of EBV-associated lymphoproliferative disorders.