Primary Epstein-Barr virus infection with pneumonia transmitted by allogeneic bone marrow after transplantation

Area of Science:

• Infectious Diseases
• Hematology
• Transplantation Immunology

Background:

• Bone marrow transplantation (BMT) is a critical treatment for various hematologic and oncologic conditions.
• Epstein-Barr virus (EBV) reactivation or primary infection post-BMT can lead to significant morbidity and mortality.
• Pre-transplant screening for EBV is crucial, though primary infections can still occur.

Observation:

• A patient, seronegative for EBV pre-transplant, developed primary EBV infection one month post-BMT.
• The patient presented with lung involvement as a manifestation of the primary EBV infection.
• The donor bone marrow was identified as the source of EBV transmission, being positive for the virus.

Findings:

• Donor-derived primary Epstein-Barr virus infection can manifest with pulmonary complications following allogeneic bone marrow transplantation.
• Serological evidence confirmed primary EBV infection in the recipient, with the virus originating from the donor graft.
• Successful management of EBV-associated lung disease was achieved using a combination of rituximab and corticosteroid therapy.

Implications:

• This case highlights the risk of primary EBV infection transmitted via donor grafts, even with pre-transplant recipient screening.
• It underscores the importance of considering donor screening for EBV in high-risk transplant scenarios.
• The successful treatment outcome demonstrates the efficacy of targeted immunosuppression (rituximab) and anti-inflammatory (corticosteroids) strategies in managing EBV-related lung disease post-BMT.