We report the case of an 18-year-old woman with colonic ileus Crohn's disease who presented with intestinal perforation requiring urgent surgical resection.
Then, treatment with azathioprine was started as prophylaxis for postoperative recurrence.
After 5 months of treatment without complications, the patient is asymptomatic until she begins with prolonged febrile syndrome of 2 weeks duration, without gastrointestinal symptoms, but with multiple adenopathies as well as hepatomegaly.
Ultrasound confirmed organomegaly and ruled out abscesses or involvement in the area of the anastomosis.
Erythema is performed showing an anastomosis with an isolated aphtha on mucous membrane ruled out inclusion bodies in biopsies or presence of virus in the tissue PCR analysis.
Analytically, there was a leukocyte transaminate alteration (GOT 90 U/l, GPT 74 U/l, GGT 144 U/l FA 153 U/l LDH 1465 U/l), and a lymphocytosis
In the microbiological study, persistently negative blood cultures, a normal Mantoux, Booster and chest X-ray were collected.
When serology tests were performed, the patient was diagnosed with mononucleic syndrome secondary to CMV and EBV infection. Heterophilic antibodies and IgM against CMV were also positive.
Antibiotic therapy was started and athioprine was discontinued.
Even so, the fever takes another week to remit, with subsequent analytical normalization and no further incidents in the follow-up introducing azathioprine 1 month later.
