title: Manifestations of fulminant CD8 T-cell post-transplant lymphoproliferative disorder following the administration of rituximab for lymphadenopathy with a high level of Epstein-Barr Virus (EBV) replication after allogeneic hematopoietic stem cell transplantation.
abstract: We herein report the case of a 22-year-old woman with severe aplastic anemia who underwent allogeneic hematopoietic stem cell transplantation (HSCT). After HSCT, the Epstein-Barr virus (EBV)-DNA load in the peripheral blood gradually increased, and the patient presented with a fever and lymphadenopathy on day 56 post-HSCT. Although we administered rituximab, her clinical condition worsened. After rituximab treatment, CD8 T-cells emerged and became dominant in the peripheral blood, some of which were positive on an EBV-specific tetramer analysis. However, an open biopsy of the lymphadenopathy lesions revealed the CD8 T-cells to be infected with EBV, exhibiting proliferation with oligoclonality. The patient ultimately died of multiple organ failure on day 99 post-HSCT.
authors.affiliation: Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Jun
authors.initials: J
authors.lastname: Takizawa
authors.forename: Shukuko
authors.initials: S
authors.lastname: Miyakoshi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kozakai
authors.forename: Kyoko
authors.initials: K
authors.lastname: Fuse
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Shibasaki
authors.forename: Masato
authors.initials: M
authors.lastname: Moriyama
authors.forename: Koichi
authors.initials: K
authors.lastname: Ohshima
authors.forename: Ken
authors.initials: K
authors.lastname: Toba
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Furukawa
authors.forename: Hirohito
authors.initials: H
authors.lastname: Sone
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Masuko
mesh_terms: D000740:Anemia / Q000628:therapy; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D004279:DNA, Viral / Q000032:analysis*; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000821:virology*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D004854:Herpesvirus 4, Human / Q000235:genetics* / Q000502:physiology; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D000069283:Rituximab; D014779:Virus Replication; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D004279:DNA, Viral; D000069283:Rituximab