Catastrophic gastrointestinal manifestations of post-transplant lymphoproliferative disorder

Post-transplant lymphoproliferative disorder is a rare complication after bone marrow transplantation and frequently involves gastrointestinal tract, but the endoscopic characteristics and catastrophic clinical manifestations in adults have not been discussed in detail. We report a 35-year-old allogeneic bone marrow transplantation recipient who presented with recurrent gastrointestinal bleeding. Ulcerative nodular lesions were noted in stomach, duodenum and ileum on endoscopy but were not biopsied because of thrombocytopenia. Obstruction and perforation of small intestine occurred 5 months after bone marrow transplantation and was managed with surgery. Histopathology revealed the diagnosis of Epstein-Barr virus related post-transplant lymphoproliferative disorder. Rituximab was given after operation but repeated intestinal perforation supervened and resulted in mortality. The characteristic endoscopic and radiographic features are presented. Recognition of these characteristic endoscopic and radiographic findings with histological confirmation is crucial in making early diagnosis, and prompt treatment may prevent gastrointestinal complications and mortality.