Post-transplantation lymphoproliferative disorder with gastrointestinal involvement

Area of Science:

• Transplant medicine
• Oncology
• Virology

Background:

• Post-transplantation lymphoproliferative disorders (PTLD) are common lymphoid tumors in transplant recipients.
• Epstein-Barr virus (EBV) is a major cause of PTLD, particularly in EBV-negative recipients.
• PTLD occurs in 1-3% of liver transplant recipients and presents variably.

Purpose of the Study:

• To report a case of aggressive B-cell lymphoma (PTLD WHO class-3) with isolated gastrointestinal involvement.
• To highlight the diagnostic challenges of EBV-negative PTLD in a liver transplant recipient.
• To emphasize the importance of vigilance for PTLD in transplant patients with gastrointestinal symptoms.

Main Methods:

• Case report of a living-donor liver transplant recipient.
• Diagnosis of aggressive B-cell lymphoma (PTLD WHO class-3) with isolated gastrointestinal involvement.
• EBV-negative status confirmed in the patient.

Main Results:

• The patient developed PTLD 4 years post-transplant.
• The PTLD presented as an aggressive B-cell lymphoma with isolated gastrointestinal manifestation.
• The patient was EBV-negative, complicating typical PTLD diagnosis.

Conclusions:

• Clinicians must maintain a high index of suspicion for PTLD, especially with isolated gastrointestinal involvement in immunocompromised patients.
• Endoscopic evaluation with biopsy is critical for prompt detection and characterization of gastrointestinal PTLD.
• This case underscores the need for vigilance in EBV-negative transplant recipients presenting with atypical symptoms.