Recurrent posttransplant lymphoproliferative disorder involving the larynx and trachea: case report and review of the literature.
OBJECTIVE
Posttransplant lymphoproliferative disorder (PTLD) is a well-recognized complication of solid organ transplantation and commonly affects upper airway lymphoid tissue. Tracheal and laryngeal involvement in patients with PTLD, however, is rare. We present one such case.


METHODS
We report the case of a patient with recurrent PTLD involving the larynx and trachea and describe the presentation, evaluation, management, and outcome.


RESULTS
An 11-year-old boy who underwent bilateral nephrectomy and renal transplantation as an infant was admitted to the hospital with chronic cough, fever, stridor, and dyspnea. His post-transplantation course was complicated by PTLD in cervical lymph nodes at 9 years of age that was successfully treated with chemotherapy. A computed tomographic scan during his present admission revealed supraglottic swelling, a distal tracheal mass, and paratracheal lymph node enlargement. The patient underwent laryngoscopy and bronchoscopy with biopsy specimens taken from the right laryngeal ventricle and distal trachea. Pathologic examination yielded a diagnosis of Epstein-Barr virus-positive PTLD. The patient was treated with chemotherapy, which resulted in resolution of the airway lesions, as seen on repeat bronchoscopy.


CONCLUSIONS
This is the first report, to our knowledge, of recurrent PTLD involving simultaneous lesions in the larynx and the trachea. PTLD in the head and neck can present as lymphoid hypertrophy, airway obstruction, stridor, or cough. A high degree of clinical suspicion is essential for prompt diagnosis of this life-threatening complication.
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Caroline A
CA
Banks
Jeremy D
JD
Meier
Christina R
CR
Stallworth
David R
DR
White
D000402:Airway Obstruction / Q000209:etiology; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001999:Bronchoscopy; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005938:Glucocorticoids / Q000008:administration & dosage; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D007830:Larynx / Q000473:pathology* / Q000821:virology; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology / Q000821:virology; D008297:Male; D009392:Nephrectomy; D012008:Recurrence; D000069283:Rituximab; D014132:Trachea / Q000473:pathology* / Q000821:virology; D016896:Treatment Outcome
D058846:Antibodies, Monoclonal, Murine-Derived; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide