Post-transplant lymphoproliferative disorder presenting on post-transplant Day 35 as a pulmonary parenchymal infiltrate-a case report

Abstract

Post-transplant lymphoproliferative disorder (PTLD), a rare but serious complication of solid organ transplantation, is classified into early-onset and late-onset subtypes. Early-onset PTLD occurs a median of 4-11 months after lung transplantation. It rarely presents in the first 2 months post-transplant. Early-onset PTLD usually presents as a solitary pulmonary nodule. We present a unique case of early-onset PTLD that was diagnosed on post-operative Day 35 and presented as a pulmonary parenchymal infiltrate. This case is also exceptional in that the patient had a significant clinical response to only a single dose of rituximab.

Figure 1:

Chest X-ray: diffuse bilateral interstitial and airspace opacities on the left greater than the right with an interval increase in size of the left lower lobe infiltrate

Figure 2:

CT chest: interval development of a dense consolidation of nearly the entire left lower lobe

Figure 3:

Post-transplant lymphoproliferative disorder diagnosed 35 days following lung transplantation. (A) Transbronchial lung biopsy of transplanted lung showing a dense polymorphous lymphoplasmacytic infiltrate (white arrows). Alveolated lung is seen at bottom (black arrow). Scattered large CD20-positive cells were present within the infiltrate (not shown). (B) Chromogenic in-situ hybridization (CISH) for Epstein-Barr virus-encoded RNA (EBER) is positive within neoplastic lymphocyte nuclei (blue signals). (A) Hematoxylin–eosin, original magnification ×200 and (B) EBER CISH, original magnification ×200.