{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T19:42:54Z","timestamp":1767987774119,"version":"3.49.0"},"reference-count":15,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,12,20]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>A middle-aged woman with a 6-year history of stable inflammatory bowel disease (IBD) presented with progressively worsening abdominal pain, increased stool frequency and rectal bleeding. Colonoscopy revealed patchy inflammation in the descending colon, and PCR testing detected 6961 copies\/mL of Epstein-Barr virus (EBV) DNA in inflamed tissue. Initial treatment with steroids and azathioprine led to partial improvement, but azathioprine had to be discontinued due to significant adverse effects. A follow-up colonoscopy demonstrated persistent inflammation, despite declining EBV DNA levels in inflamed tissue prompting the initiation of infliximab with initial improvement. However, symptoms recurred within months and secondary infliximab failure was confirmed on therapeutic drug monitoring. The patient was subsequently switched to vedolizumab and has since shown good clinical response. This case underscores the potential utility of routine EBV viral load monitoring in patients with refractory IBD and highlights the complexities of managing EBV-associated colitis with standard immunosuppression.<\/jats:p>","DOI":"10.1136\/bcr-2025-265787","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T14:35:25Z","timestamp":1767969325000},"page":"e265787","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Epstein-Barr virus colitis on a background of Crohn\u2019s disease"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6876-2532","authenticated-orcid":false,"given":"Zane","family":"Attard","sequence":"first","affiliation":[{"name":"Medicine, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Barbara","sequence":"additional","affiliation":[{"name":"Medicine, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizier","family":"Zahra Bianco","sequence":"additional","affiliation":[{"name":"Gastroenterology, Mater Dei Hospital, Msida, Malta, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Pocock","sequence":"additional","affiliation":[{"name":"Gastroenterology, Mater Dei Hospital, Msida, Malta, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"2026010906351710000_19.1.e265787.1","doi-asserted-by":"crossref","DOI":"10.1007\/s00284-023-03305-0","article-title":"Association Between Inflammatory Bowel Disease and Viral Infections","volume":"80","author":"Dehghani","year":"2023","journal-title":"Curr Microbiol"},{"key":"2026010906351710000_19.1.e265787.2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/ecco-jcc\/jjw168","article-title":"3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn\u2019s Disease 2016: Part 1: Diagnosis and Medical Management","volume":"11","author":"Gomoll\u00f3n","year":"2017","journal-title":"ECCOJC"},{"key":"2026010906351710000_19.1.e265787.3","first-page":"661","article-title":"Crohn\u2019s Disease: Diagnosis and Management","volume":"98","author":"Veauthier","year":"2018","journal-title":"Am Fam Physician"},{"key":"2026010906351710000_19.1.e265787.4","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-012-2116-5"},{"key":"2026010906351710000_19.1.e265787.5","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.3390\/v13071272","article-title":"Epstein-Barr Virus DNA Exacerbates Colitis Symptoms in a Mouse Model of Inflammatory Bowel Disease","volume":"13","author":"Andari","year":"2021","journal-title":"Viruses"},{"key":"2026010906351710000_19.1.e265787.6","doi-asserted-by":"crossref","first-page":"420","DOI":"10.4240\/wjgs.v15.i3.420","article-title":"Positive correlation between latent Epstein-Barr virus infection and severity of illness in inflammatory bowel disease patients","volume":"15","author":"Wei","year":"2023","journal-title":"World J Gastrointest Surg"},{"key":"2026010906351710000_19.1.e265787.7","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i6.1915"},{"key":"2026010906351710000_19.1.e265787.8","doi-asserted-by":"crossref","unstructured":"Zhang H , Zhao S , Cao Z . 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