Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.776
Peer-review started: June 22, 2018
First decision: August 1, 2018
Revised: August 18, 2018
Accepted: October 8, 2018
Article in press: October 8, 2018
Published online: November 26, 2018
A 19-year-old female was diagnosed with ulcerative colitis when she presented with persistent melena, and has been treated with 5-aminosalicylic acid for 4 years, with additional azathioprine for 2 years at our hospital. The patient experienced high-grade fevers, chills, and cough five d prior to presenting to the outpatient unit. At first, the patient was suspected to have developed neutropenic fever; however, she was diagnosed with Epstein-Barr virus-associated hemophagocytic syndrome (EB-VAHS) upon fulfilling the diagnostic criteria after bone marrow aspiration. When patients with inflammatory bowel disease treated with immunomodulators, such as thiopurine preparations, develop fever, EB-VAHS should be considered in the differential diagnosis.
Core tip: A 19-year-old female was diagnosed with ulcerative colitis, and has been receiving treatment with 5-aminosalicylic acid for 4 years, with additional azathioprine for 2 years. The patient experienced high-grade fever five d prior to presenting to the outpatient unit. She was diagnosed with Epstein-Barr virus-associated hemophagocytic syndrome (VAHS). VAHS is one of the rare and life-threatening pathophysiological conditions induced by thiopurine treatment. In such cases, early diagnosis is necessary, along with management of therapy, and related complications. When patients with inflammatory bowel disease, treated with immunomodulators such as thiopurine preparations, demonstrate high fever, VAHS should be considered in the differential diagnosis.