A fistulating oropharyngeal lesion

Area of Science:

• Immunology
• Oncology
• Transplantation Medicine

Background:

• Post-transplant lymphoproliferative disorder (PTLD) encompasses lymphoid proliferations arising after immunosuppression.
• While PTLD can manifest in the head and neck, tonsillar involvement is not exclusive to pediatric patients.

Purpose of the Study:

• To report a rare case of PTLD presenting with severe tonsillar ulceration in an adult renal transplant recipient.
• To discuss the diagnostic and therapeutic challenges of PTLD in the head and neck region.

Main Methods:

• A 67-year-old female renal transplant recipient presented with odynophagia and halitosis.
• Oropharyngeal examination revealed severe ulceration and erythema of the tonsillar pillars.
• Biopsy confirmed PTLD.

Main Results:

• The patient initially responded to rituximab monotherapy but experienced a recurrence.
• Subsequent chemotherapy led to a lasting remission.
• At 5-year follow-up, the patient remained PTLD-free with stable chronic kidney disease.

Conclusions:

• PTLD can present atypically in the head and neck of adult transplant recipients.
• A multi-modal treatment approach, including rituximab and chemotherapy, may be necessary for PTLD management.
• Long-term surveillance is crucial for transplant patients diagnosed with PTLD.