Epstein-Barr virus-associated post-transplant lymphoproliferative disorder diagnosed by the episode of intestinal perforation following allogeneic hematopoietic stem cell transplantation

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  • AIMOTO Mizuki
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • YAMANE Takahisa
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • INOUE Atushi
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • MOMOSE Dai
    Department of Hematology, Graduate School of Medicine, Osaka City University Department of Internal Medicine, Shitennouji Hospital
  • MORIGUCHI-AIMOTO Ran
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • WADA-INOUE Eri
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • OKAMOTO Syuuichirou
    Department of Hematology, Graduate School of Medicine, Osaka City University Department of Hematology, Osaka Tetsudou Hospital
  • KOH Hideo
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • NAKANE Takahiko
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • TAKEOKA Yasunobu
    Department of Hematology, Graduate School of Medicine, Osaka City University Department of Hematology, Osaka Saiseikai Nakatsu Hospital
  • AKAHORI-NAKAMAE Mika
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • NISHIKI-KOSAKA Saori
    Department of Hematology, Osaka Saiseikai Nakatsu Hospital
  • TERADA Yoshiki
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • NAKAMAE Hirohisa
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • KOH Ki-Ryang
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • NAKAO Takafumi
    Department of Hematology, Graduate School of Medicine, Osaka City University
  • OHSAWA Masahiko
    Department of Diagnostic Pathology, Graduate School of Medicine, Osaka City University
  • HINO Masayuki
    Department of Hematology, Graduate School of Medicine, Osaka City University

Bibliographic Information

Other Title
  • 同種造血幹細胞移植後の小腸穿孔で診断されたＥｐｓｔｅｉｎ－Ｂａｒｒ　ｖｉｒｕｓ関連移植後リンパ増殖性疾患
  • 症例報告 同種造血幹細胞移植後の小腸穿孔で診断されたEpstein-Barr virus関連移植後リンパ増殖性疾患
  • ショウレイ ホウコク ドウシュ ゾウケツ カンサイボウ イショク ゴ ノ ショウチョウ センコウ デ シンダン サレタ Epstein Barr virus カンレン イショク ゴ リンパ ゾウショクセイ シッカン

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Abstract

A 64-year-old man was diagnosed as having acute myeloid leukemia. We performed sequential treatment with chemotherapy and reduced-intensity stem cell transplantation from an unrelated donor while the patient was in partial remission. After engraftment, he developed acute graft-versus-host disease of the gut on day 42 and steroid therapy was started. Despite transient aggravation of diarrhea, his symptoms slowly improved and the dose of steroid was tapered. On day 159, he complained of acute left lower abdominal pain. A CT scan showed perforation of the digestive tract and ileectomy was performed. At surgery, multiple ulcers of the intestine were found and one of the ulcers was perforated. Pathologically, transmural and diffuse proliferation of atypical cells in the ulcer were confirmed. Since these cells were positive for CD20 and Epstein-Barr-virus (EBV) encoded RNA, we made a diagnosis of EBV-associated post-transplant lymphoproliferative disorder (PTLD). Reduction in the dose of immunosuppressive agents and rituximab led to complete remission of PTLD. PTLD after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is relatively rare, and the development of gastrointestinal perforation after allo-HSCT is very rare.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 51 (12), 1775-1780, 2010

    The Japanese Society of Hematology

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