Abstract
Posttransplant lymphoproliferative disorder (PTLD) is a serious complication following solid organ transplantation with an annual incidence rate of 3–5% in lung-transplant recipients. Pathogenesis indicates a strong association with functional over-immunosuppression and EBV infection. Clinical improvement is generally observed with reduction in immunosuppression intensity alone. We present a case of a 24-year-old woman with EBV-associated PTLD following lung transplant where decreasing the immunosuppression improved PTLD but was ineffective against controlling the EBV infection. Foscarnet in combination with immunoglobulins was successfully administered to cause a remission of the EBV infection. This is the second case reported of a persistent EBV infection after reducing immunosuppression levels and evidence of PTLD remission that required foscarnet for EBV infection control.
Highlights
The exact pathogenesis is uncertain, it is known that functional over-immunosuppression and Epstein-Barr virus (EBV) infections are strong risk factors for the development of Posttransplant lymphoproliferative disorder (PTLD)
We present a case of EBV-associated PTLD following lung transplantation showing clinical improvement of lymphadenopathy with reduction in immunosuppression intensity but having persistent EBV infection, requiring foscarnet for viral clearance
The incidence rate of PTLD in lung transplantation is between 3–5% [2]
Summary
The exact pathogenesis is uncertain, it is known that functional over-immunosuppression and Epstein-Barr virus (EBV) infections are strong risk factors for the development of PTLD. Lung-transplant recipients have at least a twofold greater risk of developing PTLD compared to other solidorgan transplants. The general therapy for PTLD includes the restoration of cellular immunity by reducing the intensity of immunosuppression. Conventional antiviral therapy with acyclovir, valganciclovir, or ganciclovir has proven ineffective, but yet remains the recommended first-line therapy for EBV infection in cases of PTLD [1]. We present a case of EBV-associated PTLD following lung transplantation showing clinical improvement of lymphadenopathy with reduction in immunosuppression intensity but having persistent EBV infection, requiring foscarnet for viral clearance
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