Posttransplantation lymphoproliferative disorder after lung transplantation

Posttransplantation lymphoproliferative disorder (PTLD) is an uncommon but often fatal complication of solid organ transplantation. The incidence is relatively higher in pediatric patients or patients undergoing lung transplantation. The pathology of PTLD is a morphologically heterogeneous group of lymphoid proliferation of varying clonal composition, most commonly of B-cell origin, and the Epstein-Barr virus (EBV) has been implicated as a cofactor in most cases. Herein we report a 44-year-old woman who underwent right single lung transplantation because of bronchiolitis obliterans associated with Sauropus androgynus ingestion. Three nodules were noted at the grafted lung 3 months after the operation. The CT-guided biopsies and serological studies revealed that these nodules were EBV-unrelated B-cell lymphoma. Despite treatment including antiviral agents, reduction of immunosuppression, as well as conventional chemotherapy, these nodules increased in size rapidly. This patient died of sepsis and respiratory failure 5 months after the transplantation.