Fatal Epstein‐Barr virus‐associated hemophagocytic lymphohistiocytosis with virus‐infected T cells after pediatric multivisceral transplantation: A proof‐of‐concept case report
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- Masaki Yamada
- Department of Advanced Medicine for Viral Infections National Center for Child Health and Development (NCCHD) Tokyo Japan
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- Seisuke Sakamoto
- Organ Transplantation Center NCCHD Tokyo Japan
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- Kenichi Sakamoto
- Children’s Cancer Center NCCHD Tokyo Japan
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- Hajime Uchida
- Organ Transplantation Center NCCHD Tokyo Japan
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- Seiichi Shimizu
- Organ Transplantation Center NCCHD Tokyo Japan
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- Tomoo Osumi
- Children’s Cancer Center NCCHD Tokyo Japan
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- Motohiro Kato
- Children’s Cancer Center NCCHD Tokyo Japan
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- Kensuke Shoji
- Division of Infectious Diseases NCCHD Tokyo Japan
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- Katsuhiro Arai
- Division of Gastroenterology NCCHD Tokyo Japan
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- Osamu Miyazaki
- Department of Radiology NCCHD Tokyo Japan
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- Noriyuki Nakano
- Department of Pathology NCCHD Tokyo Japan
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- Takako Yoshioka
- Department of Pathology NCCHD Tokyo Japan
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- Akinari Fukuda
- Organ Transplantation Center NCCHD Tokyo Japan
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- Mureo Kasahara
- Organ Transplantation Center NCCHD Tokyo Japan
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- Ken‐Ichi Imadome
- Department of Advanced Medicine for Viral Infections National Center for Child Health and Development (NCCHD) Tokyo Japan
説明
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>EBV‐associated HLH driven by EBV‐infected CD8<jats:sup>+</jats:sup> T cells is a rare complication after pediatric solid organ transplantation. The etiology and disease spectrum of post‐transplant EBV‐HLH are poorly understood, and making a precise diagnosis and providing optimal treatment remain a challenge.</jats:p></jats:sec><jats:sec><jats:title>Methods/Case description/Results</jats:title><jats:p>We report a 2‐year‐old multivisceral transplant recipient who developed fever and cytopenia with a persistent high EBV‐load state. Repeated tissue examinations and CT scans could not identify a localized mass, which is the key to the diagnosis of PTLD as per the WHO classification. Hence, EBV‐HLH was diagnosed by clinical manifestations as well as characterization of EBV‐infected cells, pathological examination on cell block of pleural effusion and clonality analysis. This EBV‐HLH did not respond to intensive chemotherapy, resulted in the recipient's death, acting similarly to hematological malignancy.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Characterization of EBV‐infected cells in peripheral blood should be considered when persistent high EBV loads develop with symptoms consistent with PTLD, but no evidence of localized mass, and the tissue diagnosis is unavailable after pediatric solid organ transplantation.</jats:p></jats:sec>
収録刊行物
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- Pediatric Transplantation
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Pediatric Transplantation 25 (3), 2020-12-28
Wiley
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詳細情報 詳細情報について
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- CRID
- 1360853567399272320
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- ISSN
- 13993046
- 13973142
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- データソース種別
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- Crossref
- KAKEN