Your browser doesn't support javascript.
loading
Epstein-Barr virus-positive lymphoproliferative disorder manifesting as pulmonary disease in a patient with acute myeloid leukemia: a case report.
Dutta, Ritika; Miao, Susanna Y; Phan, Paul; Fernandez-Pol, Sebastian; Shiraz, Parveen; Ho, Dora; Mannis, Gabriel N; Zhang, Tian Y.
Afiliación
  • Dutta R; Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA.
  • Miao SY; Stanford University School of Medicine, Stanford, CA, USA.
  • Phan P; Department of Medicine, Stanford University, Stanford, CA, USA.
  • Fernandez-Pol S; Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA.
  • Shiraz P; Department of Pathology, Stanford University, Stanford, CA, USA.
  • Ho D; Department of Medicine, Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA.
  • Mannis GN; Department of Medicine, Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA, USA.
  • Zhang TY; Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA.
J Med Case Rep ; 15(1): 170, 2021 Mar 28.
Article en En | MEDLINE | ID: mdl-33773605
ABSTRACT

BACKGROUND:

 Patients with lymphoproliferative disorders following hematopoietic stem cell transplant (HSCT) most commonly present with fever and lymphadenopathy within the first 5 months of transplant. Pulmonary post-transplant lymphoproliferative disorder (PTLD) is a particularly aggressive and rapidly progressive disease, with high morbidity and mortality. There are a very limited number of reported pulmonary PTLD cases following HSCT in patients with acute myeloid leukemia (AML). Early diagnosis and detection of pulmonary PTLD is critical given its high lethality. However, variable clinical presentations and nonspecific radiographic findings make pulmonary PTLD difficult to distinguish from other more common causes of pulmonary disease in AML patients. CASE PRESENTATION Here, we describe a 68-year-old Caucasian man who presented for salvage induction therapy following relapse of his AML after a haploidentical allogeneic HSCT 10 months earlier. He developed recurrent fevers, dry cough, and hypoxemia, with chest computed tomography (CT) showing bibasilar consolidations and increased nodularity without increased lymphadenopathy. His symptoms initially improved with antibiotic and antifungal therapy, but his follow-up chest CT showed progression of disease despite symptomatic improvement. Epstein-Barr virus (EBV) was detected in his blood by polymerase chain reaction (PCR), and a lung biopsy revealed monomorphic PTLD with B cells positive for EBV. Unfortunately, the patient's condition rapidly deteriorated, and he passed away prior to treatment initiation.

CONCLUSIONS:

 To our knowledge, this is the first reported case of an AML patient developing pulmonary PTLD relatively late in his post-transplant course in the setting of relapsed disease and salvage therapy. Pulmonary PTLD, a rare but highly lethal disorder, can imitate the symptoms and radiographic findings of pneumonia, a common diagnosis in immunocompromised AML patients. This case illustrates the importance of considering pulmonary PTLD in the differential diagnosis for pulmonary disease in AML patients with a history of HSCT, especially in the setting of progressive radiographic findings despite broad antibacterial and antifungal therapy. Further, our case demonstrates the importance of biopsy and uninterrupted EBV DNA monitoring in the definitive diagnosis of PTLD, given nonspecific symptomatology and radiographic findings.
Asunto(s)
Palabras clave

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Leucemia Mieloide Aguda / Trasplante de Células Madre Hematopoyéticas / Infecciones por Virus de Epstein-Barr / Enfermedades Pulmonares / Trastornos Linfoproliferativos Tipo de estudio: Diagnostic_studies / Screening_studies Límite: Aged / Humans / Male Idioma: En Revista: J Med Case Rep Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Leucemia Mieloide Aguda / Trasplante de Células Madre Hematopoyéticas / Infecciones por Virus de Epstein-Barr / Enfermedades Pulmonares / Trastornos Linfoproliferativos Tipo de estudio: Diagnostic_studies / Screening_studies Límite: Aged / Humans / Male Idioma: En Revista: J Med Case Rep Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos