Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2023; 15(10): 2362-2366
Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2362
Mucocutaneous ulcer positive for Epstein–Barr virus, misdiagnosed as a small bowel adenocarcinoma: A case report
Ji Hyeong Song, Ji Eun Choi, Jin Soo Kim
Ji Hyeong Song, Jin Soo Kim, Department of Surgery, Chungnam National University Sejong Hospital, Sejong 30099, South Korea
Ji Eun Choi, Department of Pathology, Chungnam National University Sejong Hospital, Sejong 30099, South Korea
Author contributions: Song JH contributed to formal analysis, investigation, and writing the original draft; Choi JE contributed to writing review, editing, and data curation; Kim JS contributed to conceptualization, methodology, project administration, supervision, validation, and visualization; and all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin Soo Kim, MD, PhD, Assistant Professor, Department of Surgery, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong-si, Sejong 30099, South Korea. jskim7562@gmail.com
Received: July 4, 2023
Peer-review started: July 4, 2023
First decision: August 4, 2023
Revised: August 18, 2023
Accepted: August 31, 2023
Article in press: August 31, 2023
Published online: October 27, 2023
Abstract
BACKGROUND

Epstein–Barr virus (EBV)-positive mucocutaneous ulcers (MCUs) are an uncommon disorder characterized by ulcerative lesions in the skin, oral cavity or gastrointestinal tract in patients with iatrogenic or aging-induced immunosuppression. The nonspecific lesions are difficult to differentiate from small bowel adenocarcinomas. We present the case of a 69-year-old woman who was initially misdiagnosed with a small bowel adenocarcinoma but was later surgically diagnosed with and treated for EBV-MCU. Through this case, we aim to emphasize the importance of accurately distinguishing between the two conditions.

CASE SUMMARY

The patient presented with an incidental finding of a small bowel tumor during computed tomography (CT) examination performed for hematuria. The CT scan showed irregular thickening of the distal ileum, which was suggestive of a malignant small bowel tumor. An exploratory laparotomy revealed an 8-cm mass in the distal ileum; thus, a segment of the small intestine, including the mass, was resected. Histopathological analysis revealed an ulceroinfiltrative mass-like lesion with luminal narrowing, marked inflammatory cell infiltration, and large atypical lymphoid cells (positive for EBV-encoded small RNA). A final diagnosis of an EBV-MCU was established. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. The patient remained recurrence-free until 12 mo after surgery.

CONCLUSION

This case highlights the diagnostic challenges for EBV-MCUs and emphasizes the importance of comprehensive evaluation and accurate histopathological analysis.

Keywords: Epstein–Barr virus, mucocutaneous ulcer, Misdiagnosis, Small bowel adenocarcinoma, Surgery, Case report

Core Tip: We report a case that highlights the diagnostic challenges of distinguishing an Epstein–Barr virus-mucocutaneous ulcer from a small bowel adenocarcinoma in a 69-year-old woman. It emphasizes the importance of performing comprehensive evaluation and accurate histopathological analysis to guide appropriate management. Awareness of this rare entity is crucial for its timely diagnosis and prevention of unnecessary invasive procedures.