Abstract: PUB238
Odynophagia: Is It Post-Transplant Lymphoproliferative Disorder?
Session Information
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Mecadon, Krista, Brown University Health, Providence, Rhode Island, United States
- Baptiste, Trevaughn Rawle, Brown University Health, Providence, Rhode Island, United States
- Patel, Pooja V., Brown University Health, Providence, Rhode Island, United States
- Merhi, Basma Omar, Brown University Health, Providence, Rhode Island, United States
Introduction
Post-transplant lymphoproliferative disorder (PTLD) is a rare but serious complication after solid organ transplant (SOT). Epstein-Barr Virus (EBV) infection or reactivation is an important risk factor for its development. Presenting symptoms can vary depending on organ involvement and are often nonspecific. We present a case of PTLD presenting with odynophagia in an EBV seroconverted kidney transplant recipient.
Case Description
51- year-old male with end stage kidney disease secondary to polycystic kidney disease underwent deceased donor kidney transplant (EBV IgG D+/R-). He received basiliximab for induction and maintained on prednisone, tacrolimus (trough of 8-10 ng/mL), and mycophenolic acid (MPA). Six months post-transplant, he presented with odynophagia, fever and unintentional weight loss. Empiric treatment with fluconazole for esophageal candidiasis failed. Neck CT scan revealed 4.2 x 3.5 cm mass on the right tongue extending superiorly towards the nasopharynx, and inferiorly into the vallecula, aryepiglottic fold, right laryngeal vestibule with ipsilateral necrotic cervical lymphadenopathy (Figure 1). Flexible laryngoscope was unsuccessful. EBV PCR demonstrated a viral load of 1,760 IU/mL. Lymph node biopsy confirmed a diagnosis of EBV positive diffuse large B-cell lymphoma with strong diffuse CD20. Staging PET-CT showed extensive disease in the throat, lymph nodes, and spleen. MPA was discontinued and patient received four weekly rituximab doses. Follow-up PET-CT showed complete metabolic response with undetectable EBV viral load. He remains on prednisone, tacrolimus (trough of 5 ng/mL), and rituximab consolidation therapy. His odynophagia resolved and his weight improved.
Discussion
PTLD occurs in 1-3% of SOT recipients within 5-years post-transplant. In our case, odynophagia was the unusual presenting feature that led to the diagnosis, underscoring the importance of considering PTLD in SOT recipients with atypical upper gastrointestinal symptoms. It also highlights the importance of early recognition of PTLD in EBV serostatus–mismatch recipients, who develop EBV seroconversion post-transplant.