4.2 Article

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

Journal

TRANSPLANT INFECTIOUS DISEASE
Volume 10, Issue 6, Pages 426-430

Publisher

WILEY
DOI: 10.1111/j.1399-3062.2008.00328.x

Keywords

transplant; post-transplant lymphoproliferative disorder; Epstein-Barr virus; oral ulcers

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D.D. Henry, S.P. Hunger, R.C. Braylan, V.R. Dharnidharka. Low viral load post-transplant lymphoproliferative disease localized within the tongueTranspl Infect Dis 2008: 10: 426-430 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/10(5) 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/10(5) 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.

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