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EBV-Associated LPD — SCE Infectious Diseases MCQ

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HardImmunocompromised HostEBV-Associated LPDSCE Infectious Diseases

A 48-year-old man with a 3-year history of Crohn disease on Azathioprine and Prednisolone 15 mg daily develops persistent fever, pancytopenia, and splenomegaly. EBV viral load is extremely high. Bone marrow biopsy shows EBV-positive atypical large B-cells. What is the most likely diagnosis?

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Correct answer: B — EBV-associated lymphoproliferative disorder / immunosuppression-related lymphoma

EBV-associated lymphoproliferative disorder (LPD) is a recognised complication of chronic immunosuppression (particularly Azathioprine combined with other immunosuppressants). Uncontrolled EBV-driven B-cell proliferation results from impaired T-cell surveillance. The spectrum ranges from reactive lymphoid hyperplasia to frank lymphoma. Management includes reduction or cessation of immunosuppression and haematology/oncology referral. Rituximab (anti-CD20) and chemotherapy may be required for aggressive disease.

Reference: ECCO 2023 – OIs in IBD; BSH 2023 – LPD