Discrepancy in EBV-DNA load between peripheral blood and cerebrospinal fluid in a patient with isolated CNS post-transplant lymphoproliferative disorder.
Post-transplant lymphoproliferative disorder (PTLD) is a fatal complication of allogeneic hematopoietic stem cell transplantation (HSCT) that is caused by reactivation of Epstein-Barr virus (EBV). A successful approach, monitoring EBV-DNA load in peripheral blood (PB) accompanied by preemptive rituximab therapy, has recently been reported. Here, we describe a 29-year-old woman who developed isolated central nervous system (CNS) PTLD. She received HSCT against acute myelogenous leukemia from a related human leukocyte antigen-haploidentical donor, following a conditioning regimen that included antithymocyte globulin. Tacrolimus and methylprednisolone were given as prophylaxis for graft-versus-host disease. On day +172, the patient's consciousness deteriorated. Magnetic resonance imaging showed six ring-enhanced lesions in the cerebral hemispheres. These tumors were diagnosed, via a craniotomy and tumorectomy, as PTLD. EBV-DNA load was elevated in the cerebrospinal fluid (CSF) but not detected in PB. She was treated with whole-brain irradiation and rituximab, and achieved partial remission of the tumors. This case serves as a reminder that vigilance is required regarding the development of isolated CNS PTLD; it is worth examining EBV-DNA replication in CSF for diagnosis even when the EBV-DNA load is negative in PB.
Department of Hematology, Saiseikai Maebashi Hospital, Kamishinden-machi 564-1, Maebashi, Gunma 371-0821, Japan. hiroakis@ked.biglobe.ne.jp
Hiroaki
H
Shimizu
Takayuki
T
Saitoh
Hiroko
H
Koya
Akinori
A
Yuzuriha
Takumi
T
Hoshino
Nahoko
N
Hatsumi
Satoru
S
Takada
Tomohito
T
Nagaki
Yoshihisa
Y
Nojima
Toru
T
Sakura
D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001927:Brain Diseases / Q000628:therapy / Q000821:virology*; D004279:DNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000235:genetics* / Q000502:physiology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008232:Lymphoproliferative Disorders / Q000628:therapy / Q000821:virology*; D011878:Radiotherapy / Q000379:methods; D000069283:Rituximab; D014184:Transplantation, Homologous; D019562:Viral Load; D014779:Virus Replication
D058846:Antibodies, Monoclonal, Murine-Derived; D004279:DNA, Viral; D000069283:Rituximab