Dynamic Presentations of Recurrent Post-Transplant Lymphoproliferative Disorder in a Heart Transplant Recipient: A...

Area of Science:

• Transplantation Medicine
• Oncology
• Virology

Background:

• Post-transplant lymphoproliferative disorders (PTLD) are serious complications following organ transplantation.
• Immunosuppressive therapy, particularly high-dose tacrolimus, is a primary risk factor for PTLD development.
• Epstein-Barr virus (EBV) viremia is commonly associated with PTLD but not always present or indicative of recurrence.

Observation:

• A 26-year-old heart transplant recipient on high-dose tacrolimus experienced recurrent PTLD.
• The patient presented with gastrointestinal symptoms including emesis, fatigue, and bloody diarrhea.
• The current PTLD episode showed minimal EBV viremia, contrasting with a previous episode with substantial EBV levels.

Findings:

• Diagnosis of recurrent PTLD was challenging due to atypical presentation and low EBV viremia.
• A history of gastrointestinal disease in the patient complicated the diagnostic process.
• Endoscopy and biopsy were crucial for confirming the gastrointestinal PTLD diagnosis.

Implications:

• This case underscores that PTLD can manifest and recur with low or undetectable EBV viremia.
• Clinical suspicion for PTLD should remain high in transplant recipients with new-onset gastrointestinal symptoms, irrespective of EBV status.
• Diagnostic strategies for PTLD may need to incorporate non-viral indicators and thorough gastrointestinal evaluations.