Lymphoproliferative Disorder as an Unusual Causen of Stridor in a Post-Liver Transplant Child / 소아알레르기및호흡기학회지

ABSTRACT

Otolaryngologic symptoms and findings are often the first manifestations of post-transplant lymphoproliferative disorder (PTLD) in children. We report a case of lymphoproliferative disorder which occurring in the epiglottis and aryepiglottic fold of a post-liver transplant, 28-month-old girl. Inspiratory stridor and mild respiratory distress were presented 7 months after the transplantation. Bronchoscopy revealed swelling of the epiglottis, multiple nodular lesions in the arytenoid and the pharyngeal wall, and collapse of the false vocal cord due to a redundant nodular mass during inspiration. Microscopic examination showed polymorphic, polyclonal small lymphoid aggregates, which were dominantly stained by monoclonal antibody to CD20. In this case, PTLD was associated with Epstein-Barr virus (EBV) infection. The patient was treated successfully by the surgical excision of the obstructing redundant mass in the arytenoids, dose reduction of immunosuppressive drugs and the administration of an antiviral agent. A diagnosis of PTLD should be considered in transplanted children who later develop upper airway obstruction.