Polyclonal B cell hyperplasia associated with Epstein-Barr virus causing acute renal allograft failure

Area of Science:

• Nephrology
• Virology
• Immunology

Background:

• Post-transplant complications can significantly impact graft survival.
• Distinguishing between rejection and infection is critical in managing transplant recipients.

Observation:

• A renal transplant recipient presented with a flu-like illness six weeks post-transplantation.
• The patient developed acute renal failure unresponsive to standard anti-rejection therapy.
• The patient died from Pneumocystis carinii pneumonia and Streptococcus viridans septicemia.

Findings:

• Autopsy revealed a diffuse polymorphic polyclonal B cell infiltrate in multiple organs, including the kidney allograft.
• Primary Epstein-Barr Virus (EBV) infection was confirmed through rising antibody titers, EBV nuclear antigen demonstration, and viral DNA detection.
• EBV-associated B cell hyperplasia was identified as the underlying cause of the observed pathology.

Implications:

• Epstein-Barr Virus (EBV) associated B cell hyperplasia can present symptomatically similar to acute organ transplant rejection.
• This condition can lead to acute allograft failure and poor patient outcomes if not accurately diagnosed.
• Early recognition and specific management strategies for EBV-driven B cell lymphoproliferative disorders are crucial in transplant recipients.