EBV-Induced Hepatitis and Juvenile Gangrenous Vasculitis: A Case Report

Karam Karam¹*, Sarah Saleh², Houssein Chebbo², Rafca Challita³, Antoine Salloum⁴, Elias Saikaly⁵ and Elias Fiani⁶

¹Department of Gastroenterology, University of Balamand, Koura, Lebanon
²Faculty of Medicine, University of Balamand, Koura, Lebanon
³Associate Professor of Rheumatology, Saint Georges Hospital UMC, Department of Internal Medicine, Lebanon
⁴Dermatology, Saint Georges Hospital UMC, Department of Dermatology, Dermatologic Surgicenter, Philadelphia, PA, United States
⁵Associate Professor of Surgery, Saint Georges Hospital UMC, Department of Surgery, Lebanon
⁶Gastroenterology, Associate Professor, Saint Georges Hospital UMC, Department of Internal Medicine, Lebanon

*Corresponding Author: Elias Fiani, Gastroenterology, Associate Professor, Saint Georges Hospital UMC, Department of Internal Medicine, Lebanon.

Received: May 06, 2024; Published: May 30, 2024

Abstract

Introduction: Juvenile gangrenous vasculitis (JGV) is a rare painful scrotal ulceration with less than 20 cases reported in the literature. The peak incidence is estimated between 5 and 45 years old. Patients usually report scrotal itching, stinging, burning or pain and these symptoms precede the development of lesions or ulcers. The etiology is unknown and in most cases no underlying infection can be identified

Case: A 29 years old male, previously healthy, presented for a three newly appearing scrotal ulcers. The patient was febrile 4 days ago and had sore throat, severe fatigue and decrease appetite without other gastrointestinal symptoms. His physical examination was pertinent for the presence of multiple pharyngeal ulcerations, a 1 cm retro-auricular adenopathy, with mild tenderness on the right upper quadrant and the presence of 3 active and painful scrotal ulcers. The EBV-VCA IgM was positive 160 U/mL (Negative < 20) confirming the presence of an acute EBV infection.

Discussion: A young patient presented with symptoms of pharyngitis, scrotal ulcer, increase in WBC, thrombocytopenia, and a perturbated liver enzymes. Workup for all viral hepatitis (A, B, C, EBV and CMV) was done to rule out hepatitis. The history of pharyngitis, the presence of thrombocytopenia, perturbated liver enzymes and hepato-splenomegaly on abdominal ultrasound was highly suggestive of EBV induced pharyngitis and hepatitis and was confirmed with the presence of a positive IgM EBV-VCA serology. A painful scrotal ulcer was noted suggestive of JGV.

JGV is a rare scrotal gangrene of unknown origin characterized by acute onset of skin ulcer and affecting mainly young patients. Notably, an association between LU and EBV is described in the literature, and this was reported too in our case. The disease is self-limited and a complete resolution within 2-3 weeks is noted.

Conclusion: EBV infection should be ruled out whenever a patient has disturbed liver enzymes, pharyngitis, hepatosplenomegaly and skin involvement, such as genital ulcers. Gastroenterologists should be prudent enough to exclude a diagnosis of JGV in context of EBV infection and genital involvement. JVG is a self-limited disease with a complete resolution in 2-3 weeks.

Keywords: Juvenile Grangrenous Vasculitis; Penile Ulcers; Genital Lesions

References

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Citation

Citation: Elias Fiani., et al. “EBV-Induced Hepatitis and Juvenile Gangrenous Vasculitis: A Case Report". Acta Scientific Gastrointestinal Disorders 7.6 (2024): 15-17.

Copyright

Copyright: © 2024 Elias Fiani., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.