EBV-associated mucocutaneous ulcer, a rare cause of a frequent problem

Journal of Surgical Case Reports, Volume 2020, Issue 4, April 2020, doi: 10.1093/jscr/rjaa057.

The case presented in the following publication¹ needs to be supplemented.

The rituximab therapy that followed the rehabilitation of the mucocutaneous ulcer provoked a rituximab-induced sarcoid-like reaction pneumopathy and steroid therapy was started.

The allocation from the rehabilitation was made with an anemic, upper gastrointestinal bleeding Forrest III. Histopathologically there was a relapse of the post-transplant lymphoproliferative disorder (PTLD). The subsequent PET-CT showed new hypermetabolic lymph nodes in the hilar and mesenteric compared to the previous examination, as well as a multifocal accumulation of FDG in the colon. As part of the progressive PTLD, chemotherapy was carried out according to the CHOP (Cyclophosphamid Hydroxydaunorubicin Vincristin Prednison)-scheme. The Mycophenolat-Mofetil therapy was stopped and the increased steroid therapy was suspended during chemotherapy.

In the course, the patient had a small intestinal volvolus and a small intestinal perforation, due to an intestinal focus of the the PTLD, histologically confirmed. Both were treated surgically. There was also CMV viremia which was treated with ganciclovir.

The four cycles of CHOP were successful with regard to the PTLD, without further proof. There were episodes of respiratory insufficiency in the run-up, multifactorial due to rituximab therapy, aspirations for dysphagia, recurrent infections and muscular weakness with secretion retention for cachexia. The patient developed pneumonia in the nadir after the fourth cycle of CHOP chemotherapy, from which he unfortunately could not recover. Palliative therapy was initiated and the patient subsequently died.

1. Hess GF, Menter T, Boll D, et al. EBV-associated mucocutaneous ulcer, a rare cause of a frequent problem. J Surg Case Rep. 2020;2020:rjaa057.