[Epstein-Barr virus-associated post-transplant lymphoproliferative disorder diagnosed by the episode of intestinal perforation following allogeneic hematopoietic stem cell transplantation].
A 64-year-old man was diagnosed as having acute myeloid leukemia. We performed sequential treatment with chemotherapy and reduced-intensity stem cell transplantation from an unrelated donor while the patient was in partial remission. After engraftment, he developed acute graft-versus-host disease of the gut on day 42 and steroid therapy was started. Despite transient aggravation of diarrhea, his symptoms slowly improved and the dose of steroid was tapered. On day 159, he complained of acute left lower abdominal pain. A CT scan showed perforation of the digestive tract and ileectomy was performed. At surgery, multiple ulcers of the intestine were found and one of the ulcers was perforated. Pathologically, transmural and diffuse proliferation of atypical cells in the ulcer were confirmed. Since these cells were positive for CD20 and Epstein-Barr-virus (EBV) encoded RNA, we made a diagnosis of EBV-associated post-transplant lymphoproliferative disorder (PTLD). Reduction in the dose of immunosuppressive agents and rituximab led to complete remission of PTLD. PTLD after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is relatively rare, and the development of gastrointestinal perforation after allo-HSCT is very rare.
Department of Hematology, Osaka City University, Osaka, Japan.
Mizuki
M
Aimoto
Takahisa
T
Yamane
Atushi
A
Inoue
Dai
D
Momose
Ran
R
Moriguchi-Aimoto
Eri
E
Wada-Inoue
Syuuichirou
S
Okamoto
Hideo
H
Koh
Takahiko
T
Nakane
Yasunobu
Y
Takeoka
Mika
M
Akahori-Nakamae
Saori
S
Nishiki-Kosaka
Yoshiki
Y
Terada
Hirohisa
H
Nakamae
Ki-Ryang
KR
Koh
Takafumi
T
Nakao
Masahiko
M
Ohsawa
Masayuki
M
Hino
D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007416:Intestinal Perforation / Q000209:etiology*; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D000069283:Rituximab; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000069283:Rituximab