Necrotic adenoids in post-transplant lymphoproliferative disorders

Area of Science:

• Otorhinolaryngology
• Transplant Immunology
• Infectious Diseases

Background:

• Post-transplant lymphoproliferative disorders (PTLD) are a serious risk following solid organ transplantation.
• Epstein Barr virus (EBV) infection is implicated in the majority of PTLD cases.
• ENT manifestations, such as tonsillar or adenoidal enlargement, are common initial signs of PTLD.

Observation:

• A 12-year-old girl presented with nasal obstruction and tonsillitis five months post-kidney transplant.
• Epstein Barr virus (EBV) DNA was detected three months after transplantation.
• Nasopharyngeal examination revealed an obstructive necrotic mass, with adenoid necrosis confirmed pathologically.

Findings:

• Adenoid necrosis, though less common than tonsillitis, can lead to significant respiratory distress.
• The presence of necrotic adenoids in a transplant patient warrants consideration of PTLD.
• EBV detection correlated with the development of ENT symptoms.

Implications:

• Otorhinolaryngologists must be vigilant for PTLD in patients presenting with ENT symptoms post-transplant.
• Prompt diagnosis and management of PTLD are essential due to its potentially fatal nature.
• This case highlights the importance of considering EBV-associated PTLD in the differential diagnosis of ENT pathology in transplant recipients.