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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
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Severe obstructive sleep apnoea due to adenotonsillar hypertrophy after liver transplantation

Omar Mulla1, Yogesh Bajaj, Lindsey Knight

  • 1Department of ENT Surgery, Leeds General Infirmary, Leeds, UK. omarmulla22@gmail.com

BMJ Case Reports
|December 6, 2012
PubMed

Insights

Epstein-Barr virus-related adenotonsillar hypertrophy can precede post-transplantation lymphoproliferative disorder. Early diagnosis is crucial in immunosuppressed patients with enlarged tonsils and adenoids, especially after organ transplant.

Area of Science:

  • Immunology
  • Pediatric Surgery
  • Otolaryngology

Background:

  • Post-transplantation lymphoproliferative disorder (PTLD) is a serious complication following organ transplantation.
  • Epstein-Barr virus (EBV) is a known risk factor for PTLD.
  • Adenotonsillar hypertrophy can cause significant airway obstruction.

Observation:

  • A 4-year-old child, 7 months post-liver transplant, presented with severe obstructive sleep apnea.
  • The child exhibited significant lymphoid hypertrophy in the oropharynx and supraglottis.
  • Surgical intervention (adenotonsillectomy and aryepiglottoplasty) led to symptom improvement.

Findings:

  • The case highlights EBV-related adenotonsillar hypertrophy as a potential precursor to PTLD.
  • Surgical management of severe airway obstruction in this context can be effective.
  • Prompt recognition of PTLD risk factors is essential.

Implications:

  • Clinicians should consider PTLD in immunosuppressed transplant recipients with adenotonsillar hypertrophy.
  • Early diagnosis and management of PTLD can improve patient outcomes.
  • This case underscores the importance of multidisciplinary care in post-transplant patients.

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