The Epstein Barr Virus: An Unusual Source of Gastritis: 2342

The Epstein-Barr virus (EBV) has been implicated in both causing and mimicking lymphoma. Its association with gastritis has rarely been documented in the literature. We present a case of EBV-associated gastritis with features suspicious for malignancy. A 29-year-old female with menorrhagia presented with abdominal pain, nausea, vomiting, sore throat, fatigue, fevers and chills for 7 days prior to admission. Her family history was significant for gastric polyps in her mother and gastric cancer in her maternal grandmother. On physical exam, she was afebrile with a resting tachycardia. She had diffuse abdominal tenderness to palpation without rebound or guarding. She had a hemoglobin 6.3 g/dL, platelet count 118 x 10ˆ3/mcL, and WBC of 9.24 x 10ˆ3/mcL with 62% lymphocytes and occasional atypical lymphocytes. Her iron panel was positive for deficiency. Her comprehensive metabolic profile was normal. Her stool was positive for occult blood. An abdominal ultrasound showed a thickened gallbladder wall, with hepatobiliary scan showing an ejection fraction of 0% with unusual blood pooling activity in the left upper quadrant. After adequate transfusion and proton pump inhibitor therapy, she underwent an EGD that revealed polypoid masses within the stomach and no foci of bleeding. Tissue biopsy showed gastric oxyntic mucosa with increased numbers of chronic inflammatory cells in the lamina propria which included lymphocytes and plasma cells. Helicobacter pylori immunostaining was negative and in situ hybridization for Epstein-Barr virus RNA (EBER) was positive. Antral polyp histology revealed edema of the lamina propria, reactive changes and moderate chronic active inflammation. The gastric antral mucosa showed moderate chronic gastritis. An abdominal CT showed splenomegaly and inguinal lymphadenopathy. An inguinal lymph node was biopsied and revealed polymorphous lymphocytes without necrosis, granuloma or tumor. Heterophile antibody testing was positive. With clinical improvement, the patient discharged home with PPI therapy and returned for follow up 2 months with full resolution of symptoms and negative H. pylori and EBER studies on repeat upper endoscopy.Figure 1Figure 2This case highlights the rarely described EBV-gastritis and the ability of EBV to mimic malignancy via radiographic, endoscopic, and histologic assessment. Differentiation of acute EBV infection from malignancy is imperative.