Airway obstruction in an immunosuppressed child

Recipients of organ transplants who require continuous immunosuppression appear to have an increased incidence of lymphoproliferative disorders. A case of severe upper airway obstruction resulted from adenotonsillar hypertrophy in a 2-year-old girl following liver transplantation. Tonsillectomy and adenoidectomy dramatically reversed the airway problem and confirmed a transplant-associated lymphoproliferative disorder. A generalized lymphadenopathy also regressed with reduction of cyclosporine immunosuppression. We urge vigilance in monitoring transplant recipients, particularly children, for problems of upper airway obstruction and advocate prompt biopsy of persistently enlarged lymphoid tissue in all immunosuppressed individuals who fail to respond to conventional medical therapy.