title: Low viral load post-transplant lymphoproliferative disease localized within the tongue.
abstract: Post-transplant lymphoproliferative disease (PTLD) can occur in different sites, such as lymph nodes, allograft, and central nervous system. We report a 6-year-old girl with end-stage renal disease secondary to hypoplastic-dysplastic kidneys, who received a kidney transplant. Thirty months post transplant, she developed PTLD in the tongue, an area of muscular tissue only. At that time her peripheral blood Epstein-Barr viral (EBV) load was only 40 copies/10(5) lymphocytes, though the tumor was EB early RNA (EBER) positive. Immunosuppression was reduced with initial improvement in her symptoms. One month later, she returned with abdominal complaints and a contained cecal abscess. The excised cecal tissue revealed CD20 and EBER-positive lymphoid cells. At the same time, her peripheral blood EBV copy number rose to 400 copies/10(5) lymphocytes. She was successfully treated for the progressive PTLD by complete cessation of immunosuppression and a modified reduced-dose chemotherapy protocol plus rituximab. Partial immunosuppression was eventually re-introduced with sirolimus and prednisone. She remains in remission 60 months post transplant, and 30 months post PTLD, with serum creatinine value maintained at 1.3 mg/dL. Unusual localization of PTLD to areas in non-lymphoid tissue without regional lymphoid involvement may result in misleading low peripheral blood EBV viral loads.
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32610-0296, USA.
authors.forename: D D
authors.initials: DD
authors.lastname: Henry
authors.forename: S P
authors.initials: SP
authors.lastname: Hunger
authors.forename: R C
authors.initials: RC
authors.lastname: Braylan
authors.forename: V R
authors.initials: VR
authors.lastname: Dharnidharka
mesh_terms: D000038:Abscess / Q000209:etiology / Q000473:pathology; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D002432:Cecum / Q000473:pathology; D002648:Child; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D000069283:Rituximab; D020123:Sirolimus / Q000009:adverse effects / Q000627:therapeutic use; D014062:Tongue Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D019562:Viral Load
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab; D011241:Prednisone; D020123:Sirolimus