Supplementary Material for: Chronic Active Epstein-Barr Virus Infection-Associated Hydroa Vacciniforme-Like Eruption and Behçet's-Like Orogenital Ulcers

The cutaneous manifestations of chronic active Epstein-Barr virus (EBV) infection can be diverse. Among them, hydroa vacciniforme-like eruption is one of the best-known features. Although rare, mucosal ulcers have been reported to be associated with EBV as a result of primary infection or immune suppression. We describe a 65-year-old female with recurrent necrotic papulovesicles on the face and both arms for 2 years. She also complained of recurrent oral and genital mucosal ulcers developing simultaneously with skin eruptions. They appeared periodically during the spring and summer and were triggered or aggravated by sun exposure. Skin biopsies from the face and genitalia showed identical findings with dense lymphocytic infiltrations. In addition, in situ hybridization revealed EBV-positive lymphoid cells in both specimens. To our knowledge, this is the first case of serologically and pathologically proven chronic active EBV infection presenting hydroa vacciniforme-like eruption and orogenital ulcers at the same time in one patient.慢性活动性爱泼斯坦-巴尔病毒（Epstein-Barr virus，EBV）感染的皮肤表现多样，其中种痘样水疱病样皮疹是最为人熟知的特征之一。尽管黏膜溃疡较为罕见，但已有研究报道其可因原发性EBV感染或免疫抑制而与EBV相关。本文报告1例65岁女性患者，2年来面部及双臂反复出现坏死性丘疹水疱，同时伴发与皮疹同步出现的口腔及生殖器黏膜溃疡。上述皮损与溃疡均于春夏季周期性发作，且可因日晒诱发或加重。面部及生殖器部位的皮肤活检标本可见一致的致密淋巴细胞浸润；此外，原位杂交（in situ hybridization）检测证实两份标本中均存在EBV阳性淋巴细胞。据我们所知，本病例为首例经血清学及病理学证实的慢性活动性EBV感染患者，同时表现为种痘样水疱病样皮疹与口生殖器溃疡。