PMID- 11272609
OWN - NLM
STAT- MEDLINE
DCOM- 20010405
LR  - 20191104
IS  - 1397-3142 (Print)
IS  - 1397-3142 (Linking)
VI  - 4
IP  - 2
DP  - 2000 May
TI  - Epstein-Barr virus-associated post-transplant lymphoproliferative disease after 
      bone marrow transplantation mimicking graft-versus-host disease.
PG  - 151-5
AB  - In contrast to solid organ transplantation (Tx), the incidence of post-transplant 
      lymphoproliferative disease (PTLD) after hematopoietic stem cell Tx (HSCT) is 
      generally low. This risk, however, is significantly elevated in patients 
      receiving human leukocyte antigen (HLA) mis-matched or T-cell-depleted grafts, or 
      after treatment for severe graft-versus-host disease (GvHD). An 18-yr-old patient 
      with positive Epstein-Barr virus (EBV) serology received a fully matched, 
      unmanipulated bone marrow graft from an unrelated EBV-positive donor for 
      treatment of acute myeloid leukemia (AML) in second complete remission. GvHD 
      prophylaxis was performed with cyclosporin A (CsA) and a short course of 
      methotrexate. Four months after Tx, the patient developed ulcerative tonsillitis 
      that was unresponsive to antibiotic treatment. Diarrhea appearing simultaneously 
      was interpreted as gastrointestinal GvHD and steroids were added to CsA. A few 
      days later the patient was admitted to hospital because of generalized seizure 
      and pneumonia. Despite reduction of immunosuppression, intensification of 
      anti-viral treatment, and subsequent mechanical ventilation, the patient died of 
      acute respiratory distress 6 days later. Autopsy demonstrated disseminated 
      EBV-induced, multi-nodular lymphoma infiltration of the entire colon but no signs 
      of GvHD. Moreover, both lungs, paratracheal lymph nodes, kidneys, thyroid gland, 
      and liver were infiltrated with large B-cell non-Hodgkin's lymphomas. This case 
      underlines the rapid and aggressive course of EBV-induced disseminated PTLD after 
      HSCT, initially mimicking intestinal GvHD because of massive colonic lymphoma 
      infiltration. Tissue biopsies should be performed early for establishing correct 
      diagnosis, thus enabling specific therapy, e.g. infusion of donor leukocytes with 
      cytotoxic T-lymphocytes.
FAU - Claviez, A
AU  - Claviez A
AD  - Department of Pediatrics, University of Kiel, Germany. 
      a.claviez@pediatrics.uni-kiel.de
FAU - Tiemann, M
AU  - Tiemann M
FAU - Wagner, H J
AU  - Wagner HJ
FAU - Dreger, P
AU  - Dreger P
FAU - Suttorp, M
AU  - Suttorp M
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Denmark
TA  - Pediatr Transplant
JT  - Pediatric transplantation
JID - 9802574
SB  - IM
MH  - Adolescent
MH  - Diagnosis, Differential
MH  - Epstein-Barr Virus Infections/*diagnosis
MH  - Fatal Outcome
MH  - Graft vs Host Disease/diagnosis/prevention & control
MH  - *Hematopoietic Stem Cell Transplantation
MH  - Humans
MH  - Leukemia, Myeloid, Acute/*therapy
MH  - Lymphoproliferative Disorders/diagnosis/*virology
MH  - Male
EDAT- 2001/03/29 10:00
MHDA- 2001/04/06 10:01
CRDT- 2001/03/29 10:00
PHST- 2001/03/29 10:00 [pubmed]
PHST- 2001/04/06 10:01 [medline]
PHST- 2001/03/29 10:00 [entrez]
AID - 10.1034/j.1399-3046.2000.00108.x [doi]
PST - ppublish
SO  - Pediatr Transplant. 2000 May;4(2):151-5. doi: 10.1034/j.1399-3046.2000.00108.x.