title: Post-transplant Lymphoproliferative Disorders: A Rare Case of Primary Pericardial Involvement Epstein-Barr Virus-Correlated in Heart Transplantation.
abstract: Post-transplant lymphoproliferative disorders (PTLDs) are considered a fatal consequence of immunosuppression. We report a case of a 52-year-old patient, who underwent a cardiac transplantation and presented undefined recurrent episodes of pleuropericardial effusions without lymphoadenomegaly at chest radiographs and computed tomography. Histopathological analysis of the bioptic pericardium showed a specific chronic inflammation. Monitoring endomyocardial biopsies (EMBs) showed only 1 episodes of greater than grade 2R acute cellular rejection requiring immunosuppressive treatment, mild vasculitis in 2 subsequently EMBs while constantly negative for antibody-mediated rejection or infection. Only a post-mortem examination demonstrated the presence of an aggressive acute non-Epstein-Barr virus (EBV)-related proliferative disorder with unusual primitive localization into the pericardium and with coronary epicardial and intramyocardial necrotizing vasculitis and superimposed occlusive and subocclusive thrombosis. Recurrence of unexplained early pleuropericardial effusion and mild intramyocardial vasculitis should raise the suspicion of PTLD requiring reduction of immunosuppression, even in the setting of negative intramyocardial cellular infiltrate and tissue EBV-negative molecular assessment.
authors.affiliation: Heart Transplant Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy. Electronic address: giuseppe.toscano@sanita.padova.it.
authors.forename: G
authors.initials: G
authors.lastname: Toscano
authors.affiliation: Heart Transplant Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Fabozzo
authors.affiliation: Pathological Anatomy, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Fedrigo
authors.affiliation: Heart Transplant Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gambino
authors.affiliation: Pathological Anatomy, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Angelini
authors.affiliation: Heart Transplant Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gerosa
mesh_terms: D001706:Biopsy; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000175:diagnosis; D017809:Fatal Outcome; D016027:Heart Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000175:diagnosis / Q000209:etiology*