Low viral load post-transplant lymphoproliferative disease localized within the tongue

D. D. Henry, S. P. Hunger, R. C. Braylan, V. R. Dharnidharka

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Post-transplant lymphoproliferative disease (PTLD) can occur in different sites, such as lymph nodes, allograft, and central nervous system. We report a 6-year-old girl with end-stage renal disease secondary to hypoplastic-dysplastic kidneys, who received a kidney transplant. Thirty months post transplant, she developed PTLD in the tongue, an area of muscular tissue only. At that time her peripheral blood Epstein-Barr viral (EBV) load was only 40 copies/105 lymphocytes, though the tumor was EB early RNA (EBER) positive. Immunosuppression was reduced with initial improvement in her symptoms. One month later, she returned with abdominal complaints and a contained cecal abscess. The excised cecal tissue revealed CD20 and EBER-positive lymphoid cells. At the same time, her peripheral blood EBV copy number rose to 400 copies/105 lymphocytes. She was successfully treated for the progressive PTLD by complete cessation of immunosuppression and a modified reduced-dose chemotherapy protocol plus rituximab. Partial immunosuppression was eventually re-introduced with sirolimus and prednisone. She remains in remission 60 months post transplant, and 30 months post PTLD, with serum creatinine value maintained at 1.3 mg/dL. Unusual localization of PTLD to areas in non-lymphoid tissue without regional lymphoid involvement may result in misleading low peripheral blood EBV viral loads.

Original languageEnglish
Pages (from-to)426-430
Number of pages5
JournalTransplant Infectious Disease
Volume10
Issue number6
DOIs
StatePublished - Dec 2008

Keywords

  • Epstein-Barr virus
  • Oral ulcers
  • Post-transplant lymphoproliferative disorder
  • Transplant

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