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Conjunctival posttransplantation lymphoproliferative disorder.

R Christopher Walton1, Mihaela M Onciu, Farhan A Irshad

  • 1Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee College of Medicine, Memphis, Tennessee 38163, USA. cwalton@utmem.edu

American Journal of Ophthalmology
|May 26, 2007
PubMed
Summary
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Posttransplantation lymphoproliferative disorder (PTLD) can affect the conjunctiva, presenting as a rare masquerade syndrome. This case highlights successful treatment of conjunctival PTLD in a pediatric bone marrow transplant patient.

Area of Science:

  • Ophthalmology
  • Oncology
  • Transplantation Immunology

Background:

  • Posttransplantation lymphoproliferative disorder (PTLD) is a rare but serious complication following organ or bone marrow transplantation.
  • Ocular involvement of PTLD is uncommon, often presenting as a diagnostic challenge due to its varied clinical manifestations.

Observation:

  • An 8-year-old boy, 3 months post-bone marrow transplant, presented with bilateral conjunctival masses.
  • Ocular examination revealed enlarged, gelatinous bulbar conjunctiva.

Findings:

  • Conjunctival biopsy confirmed a polymorphous lymphoid infiltrate with atypical immunoblastic lymphoma cells, positive for B-cell markers (CD20, CD79a).
  • Epstein-Barr virus (EBV)-encoded RNA was detected in most cells, indicating EBV-related PTLD.

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  • Treatment involved immunosuppression withdrawal and EBV-specific cytotoxic T lymphocytes, leading to complete resolution of conjunctival lesions within five weeks.
  • Implications:

    • This case expands the known clinical spectrum of ocular PTLD, emphasizing the conjunctiva as a potential site of involvement.
    • Early diagnosis and appropriate management, including targeted immunotherapy, are crucial for favorable outcomes in conjunctival PTLD.
    • Ophthalmologists should consider PTLD in the differential diagnosis of unexplained conjunctival lesions in transplant recipients.