Post-transplant lymphoproliferative disorder arising in solid organs (lungs and liver) after hematopoietic stem cell transplantation: a case report

Introduction This study aims to investigate the diagnosis and management of post-transplant lymphoproliferative disorder (PTLD) involving solid organs following allogeneic hematopoietic stem cell transplantation (allo-HSCT). We conducted a retrospective analysis of clinical data from a patient who developed PTLD in solid organs (lungs and liver) after the second allo-HSCT at Beijing GaoBo Boren Hospital. Case presentation A 26-year-old Han Chinese male, employed at a company, was initially diagnosed with T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma (T-ALL/LBL) and underwent his first haploidentical HSCT (with his father as the donor). Two months post-transplant (+ 2 months), he was diagnosed with cytomegalovirus (CMV)/Epstein-Barr virus (EBV) viremia, which resolved following symptomatic treatment. At + 3 months post-transplant, he presented with tonsillar swelling, and pathological examination confirmed PTLD. The patient achieved remission following treatment with glucocorticoids combined with four doses of rituximab. At + 6 months post-transplant, painful masses appeared in the right neck and right upper arm, and pathological results indicated a relapse of the primary disease (T-ALL/LBL). He was admitted to Beijing GaoBo Boren Hospital and subsequently underwent a second allo-HSCT from an unrelated donor with a full HLA match (10/10). Six months after the second transplant, he developed severe EBV-positive PTLD, initially presenting with recurrent fever and pulmonary nodules, followed by the appearance of rounded low-density lesions in the liver and subcutaneous tissue. No generalized lymphadenopathy was observed. Following pathological confirmation of PTLD, the patient received chemotherapy and achieved complete remission. Conclusion PTLD, a complication of allo-HSCT, may occur exclusively in solid organs without lymph node involvement. PTLD localized to solid organs is prone to misdiagnosis; thus, precise treatment should be initiated only after confirmation by pathological biopsy.