Epstein–Barr virus positive gastric adenocarcinoma with systemic EBV reactivation in a patient with persistently active systemic lupus erythematosus

Abstract Objectives Epstein–Barr virus (EBV) has been associated with several types of cancers, most often nasopharyngeal carcinomas and hematological malignancies. It is also suggested that EBV significant role in the pathogenesis different autoimmune diseases including systemic lupus erythematosus (SEL). The exact mechanisms behind these processes are not elucidated. Case presentation We present a case 52-years old female patients moderately active SLE presenting severe fatigue, purpuric lesions, alopecia, polyarthritis, mucosal ulcerations, progressive thrombocytopenia over period 10 months. During work-up, patient was evaluated for viral infections. Serology testing showed elevation anti-EBV, anti-CMV anti-HSV1/2 IgM antibodies presence IgG against all mentioned viruses except HSV2. Corticosteroid therapy escalated, azathioprine introduced. Due to persistence monoclonal sternal puncture performed. Morphological immunohistochemical analysis bone marrow specimen presented infiltration metastatic deposits adenocarcinoma plasmacytosis. Esophagogastroduodenoscopy multiple prepyloric erosions gastric mucosa, which were biopsied. Pathohistological demonstrated mucosa diffuse type adenocarcinoma. Further PCR biopsied revealed DNA carcinoma tissue. sent oncologist further evaluation. Conclusions Assessment persistently disease should include herpesvirus infection status. Reactivations may be considered as possible trigger flares factor increased risk developing