BMJ Case Reports 2018; doi:10.1136/bcr-2018-224963
  • Reminder of important clinical lesson

EBV colitis with ulcerative colitis: a double whammy

  1. Gaurav Bhaskar Nigam
  1. Gastroenterology, Royal Oldham Hospital, Oldham, Oldham, UK
  1. Correspondence to Dr Gaurav Bhaskar Nigam, drgauravbnigam{at}
  • Accepted 17 June 2018
  • Published 29 June 2018


We report this case of a 21-year-old immunocompetent man presenting with ulcerative colitis and superimposed Epstein-Barr virus (EBV) colitis. He presented for the first time with symptoms of blood-mixed diarrhoea and raised inflammatory markers. His endoscopic and histological appearances were found to be due to ulcerative colitis for which he was started on standard therapy with intravenous steroids. In spite of this, he continued to be symptomatic and his inflammatory markers continued to rise. A virology screen done showed evidence of previous EBV infection, and in view of poor response to immunosuppression, a superimposed infection was suspected. EBV DNA PCR done on colonic biopsies was found to be positive and the patient was started on intravenous ganciclovir to which he responded well. This case highlights the importance of considering a superimposed infection in patients with poor initial response to steroid therapy in inflammatory bowel disease.


  • Contributors MA: Consultant under whom the patient was admitted. GBN: Registrar, edited and updated the literature.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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