EBV-associated B- and T-cell posttransplant lymphoproliferative disorders following primary EBV infection in a kidney transplant recipient

• Published in: American journal of clinical pathology Vol. 123; no. 2; pp. 222 - 228
• Main Authors: YIN, C. Cameron, MEDEIROS, L. Jeffrey, ABRUZZO, Lynne V, JONES, Dan, FARHOOD, Anwar I, THOMAZY, Vilmos A
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Society of Clinical Pathologists 01.02.2005
• Subjects: B-Lymphocytes - immunology; B-Lymphocytes - pathology; Biological and medical sciences; Bone Marrow - pathology; Bone Marrow - virology; Cell Proliferation; Child, Preschool; Clone Cells; DNA, Neoplasm - analysis; Epstein-Barr virus; Epstein-Barr Virus Infections - complications; Epstein-Barr Virus Infections - genetics; Epstein-Barr Virus Infections - pathology; Fatal Outcome; Female; Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor - genetics; Hematologic and hematopoietic diseases; Herpesvirus 4, Human - genetics; Herpesvirus 4, Human - isolation & purification; Humans; Immunophenotyping; Investigative techniques, diagnostic techniques (general aspects); Kidney Transplantation; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Liver - pathology; Liver - virology; Lymph Nodes - pathology; Lymph Nodes - virology; Lymphoproliferative Disorders - genetics; Lymphoproliferative Disorders - pathology; Lymphoproliferative Disorders - virology; Medical sciences; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Postoperative Complications; T-Lymphocytes - immunology; T-Lymphocytes - pathology; Primary infection; Transplantation; Epstein Barr virus; Homotransplantation; Kidney; Bilineage; B cell; Posttransplant lymphoproliferative disorder; Surgery; Lymphoproliferative syndrome; T-Lymphocyte; Graft; Epstein-Barr virus; β Cell; Monoclonal; Monoclonal immunoglobulin; Gammaherpesvirinae; Herpesviridae; T cell; Malignant hemopathy; B-Lymphocyte; Virus; Anatomic pathology; Treatment; Urinary system; Kidney transplantation
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1309/PH2BK79HAVTTPW13

Posttransplant lymphoproliferative disorders (PTLDs) usually are of B-cell lineage and associated with Epstein-Barr virus (EBV). PTLDs of T-cell lineage are much less common and infrequently associated with EBV. We report a rare case of a girl in whom B-cell and T-cell PTLDs developed following 2 EBV-negative kidney transplants. Within 2 years of the second transplantation, the originally EBV-negative patient developed both an EBV-associated clonal B-cell PTLD involving lymph nodes and an EBV-positive T-cell PTLD involving bone marrow and liver. These proliferations occurred concurrently with evidence of primary EBV infection and high plasma viral load. The patient eventually died of multiorgan failure 5 years after the initial transplant (3 years after the second transplant). To our knowledge, only 4 cases of both B-cell and T-cell PTLDs have been reported. Only 2 cases have been proven to be monoclonal and EBV-associated, as in this case, the first following kidney transplantation.