A rare cause of ulcerative colitis - diarrhoea and perianal bleeding due to posttransplant lymphoproliferative disorder (PTLD).
Post-transplant lymphoproliferative disorder (PTLD) is characterised by frequent extranodal manifestation, in 20 - 25 % including the gastrointestinal tract. This entity, which is more frequent after solid organ transplantation, rarely occurs after bone marrow transplantation (BMT). We report the case of a 43-year-old male presenting with a short history of rectal bleeding, diarrhoea and weight loss. He had received a bone marrow transplant two years previously for an acute lymphocytic leukaemia of B-cell origin. On sigmoidoscopy, deep ulcerations of the rectal and sigmoideal mucosa were found. Further investigations revealed a diffuse infiltration of the liver, spleen, both kidneys and lungs. Histologically, a monomorphic post-transplant lymphoproliferative disorder was diagnosed, the subtype was a high grade diffuse-large cell Non-Hodgkin's lymphoma of B-cell origin. The biopsies showed that a major proportion of cells expressed Epstein-Barr virus encoded proteins typical for latent as well as lytic EBV infection. This is a common feature of PTLD and possibly plays a critical role in its pathogenesis. The current therapeutic approach to the subtype of PTLD we saw in this patient is CHOP chemotherapy, comprising the anti-CD 20 antibody rituximab if CD 20-positivity is present. This patient had a fatal course of the disease and died a few days after the first chemotherapy cycle due to severe multiple organ failure.
Godt
C
C
Department of Medicine, Hospital Bremen-Ost, Bremen. cgodt@gmx.de
Regnery
A
A
Schwarze
B
B
Junker
K
K
Porschen
R
R
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000209:etiology* / Q000473:pathology; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003967:Diarrhea / Q000209:etiology* / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012812:Sigmoidoscopy
D000970:Antineoplastic Agents