Lymphoproliferative disorder in a lung transplant recipient

Abstract

Post-transplantation lymphoproliferative disorder (PTLD) is uncommon following solid organ transplantation. We present a case of PTLD presenting as hematochezia and abdominal pain in a 66-year-old man, who had undergone bilateral lung transplantation with alemtuzumab induction 7 months prior to presentation. The transplant serologic status was "high-risk" for the presence of both Epstein-Barr virus (EBV) serologies in the donor and negative serologies in the recipient. Biopsies taken during colonoscopy stained strongly positive for EBV-encoded RNA. Mediastinal lymph node biopsies also showed atypical, EBV-positive lymphohistiocytic infiltration with focal necrosis. The patient's hospital course was complicated by treatment side effects, most notably bowel perforation following rituximab. In this case report the topic of PTLD is reviewed and consideration is given to whether alemtuzumab induction may have contributed to the patient's development of PTLD.

Keywords: immunological products and vaccines; oncology; transplantation.

Figure 1

Colonoscopy demonstrating the presence of ulceration.

Figure 2

(A) H&E sections from colonic biopsies demonstrate diffuse infiltration by atypical lymphocytes with large, pleomorphic nuclei with contour irregularities, prominent nucleoli, and a moderate amount of eosinophilic cytoplasm. (B) The atypical cells are strongly EBV positive. EBV, Epstein-Barr virus.