*Current affiliation: Department of Pediatrics, University of Colorado, Colorado, USA.
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Low viral load post-transplant lymphoproliferative disease localized within the tongue
Article first published online: 24 JUL 2008
DOI: 10.1111/j.1399-3062.2008.00328.x
© 2008 Wiley Periodicals, Inc.
Additional Information
How to Cite
Henry, D.D., Hunger, S.P., Braylan, R.C. and Dharnidharka, V.R. (2008), Low viral load post-transplant lymphoproliferative disease localized within the tongue. Transplant Infectious Disease, 10: 426–430. doi: 10.1111/j.1399-3062.2008.00328.x
This case was presented in abstract form at the 4th Congress of the International Pediatric Transplant Association in March 2007 at Cancun, Mexico.
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*Current affiliation: Department of Pediatrics, University of Colorado, Colorado, USA.
Publication History
- Issue published online: 12 NOV 2008
- Article first published online: 24 JUL 2008
- Received 23 January 2008, revised 25 February 2008, accepted for publication 13 March 2008
- Abstract
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- Cited By
Keywords:
- transplant;
- post-transplant lymphoproliferative disorder;
- Epstein–Barr virus;
- oral ulcers
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.