J Korean Soc Transplant.  2013 Sep;27(3):138-142. 10.4285/jkstn.2013.27.3.138.

Posttransplant Lymphoproliferative Disorder without Epstein-Barr Virus Presented as Small Bowel Perforation in Renal Transplant Recipient: A Case Report

• Kim MJ
• Shim H
• Jang JY
• Lee SH
• Huh KH
• Kim YS
• Lee JG

• KMID: 1495872
• DOI: http://doi.org/10.4285/jkstn.2013.27.3.138

Abstract

Posttransplant lymphoproliferative disorder (PTLD) is documented as one of the serious complications leading to mortality particularly in organ transplant recipients receiving immunosuppressive therapy. Extant literature confirms beyond doubt that the most common site of involvement of PTLD is lymph nodes, and rarely involved is the gastrointestinal tract. It is a well-known fact that Epstein-Barr virus (EBV) is a risk factor for PTLD development. In this study, we report a case of PTLD presented as small bowel perforation without EBV infection after long-term immunosuppressive therapy in a renal transplant recipient.

Keyword

Posttransplant lymphoproliferative disease; Small bowel perforation; Kidney transplantation

MeSH Terms

Epstein-Barr Virus Infections
Gastrointestinal Tract
Herpesvirus 4, Human
Kidney Transplantation
Lymph Nodes
Lymphoproliferative Disorders
Risk Factors
Transplants

Figure

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  Fig. 1. (A) Chest X-ray and (B) abdominal computed tomography (CT) scan in the emergency room. In chest X-ray did not show the subdiaphragmatic free air repre-senting bowel perforation. Right lung showed the posttuberculosis sequelae with fibrosis and ate-lectasis combined with pleural ef-fusion. In CT scan showed the in-traperitoneal free air (arrows), and the focus of perforation was not defined.

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  Fig. 2. The perforation site of small intestine were identified by gross pathology (arrows). (A) Extraluminal view. (B) Intraluminal view.

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  Fig. 3. (A) Transmural involvement of the small bowel by the lesion (black arrows) (HE stain, ×12.5). (B) The mass consists of predom-inantly large transformed cells containing huge cytoplasm (immunehistochemistry stain, ×200). (C) The large transformed cells were positive for CD20 (immunehistochemistry, ×40). (D) The transformed cells were also positive for blc-2 (immunehistochemistry, ×40).

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