Endobronchial Post-transplant Lymphoproliferative Disease in a Child

This is the authors' abstract. We don't add key points for this paper.

A 13-year-old male with dilated cardiomyopathy of unknown cause underwent a heart transplant from an Epstein-Barr virus (EBV)-positive donor. Five months later, a scoliosis X-ray revealed incidental nodular lung opacities (Figure 1). His only complaint was a mild cough. Examination revealed scattered wheezing and bilateral nontender cervical nodes. Blood culture, fungal serology, and QuantiFERON-TB Gold test were negative. Notably, his EBV titers, which were negative at the time of transplant and <501 IU/ml post-transplant, had risen to 3,681 IU/ml. A computed tomography scan demonstrated noncalcified, noncavitary nodules in the left upper lobe and a right perihilar endoluminal mass (Figure 2). Post-transplant lymphoproliferative disorder (PTLD) was suspected. Flexible bronchoscopy revealed a necrotic endoluminal mass in the right bronchus intermedius (Figure 3). Biopsies of this lesion and a left upper lobe nodule demonstrated CD20+ (cluster of differentiation 20 positive) PTLD (Figure 4), which is favored to represent the polymorphic subtype. No other endoluminal masses were found. He was treated with cyclophosphamide, prednisone, and rituximab. After 6 months, the endoluminal mass was undetectable and the left upper lobe nodules were significantly smaller. He is presently in remission.