Japanese Journal of Clinical Oncology 33:408-412 (2003)
© 2003 Foundation for Promotion of Cancer Research
Multiple Pulmonary Nodules Caused by B-Cell Post-transplant Lymphoproliferative Disorder after Bone Marrow Transplantation: Monitoring Epstein–Barr Virus Viral Load
1 First Department of Internal Medicine, 2 Intractable Disease Therapeutic Center and 3 First Department of Pathology, Tokyo Medical University, Tokyo, Japan
We report a patient with myelodysplastic syndrome who underwent an allogeneic bone marrow transplantation during the first remission. On day 110 he had a low-grade fever and pulmonary nodules, without superficial lymphadenopathy, were observed. The pulmonary nodules gradually increased in size and in number despite administration of anti-fungal and anti-tuberculosis agents. Transbronchial lung biopsy was performed on day 204, yielding a diagnosis of polyclonal post-transplant lymphoproliferative disease (PTLD) positive for Epstein–Barr virus (EBV)-encoded RNA (EBER) and CD20. Subsequent measurement of herpesvirus viral load demonstrated a consistent elevation of EBV viral load from day 96 to day 221. After treatment with anti-CD20 monoclonal antibody (rituximab), regression of pulmonary nodules was confirmed and the number of EBV genome copies decreased to a normal range. This case suggests that monitoring the quantitative EBV viral load may be necessary in cases of EBV-associated PTLD, even in cases presenting pulmonary nodules. Solitary pulmonary nodules may be a rare symptom of PTLD, but in such cases, an aggressive approach may be necessary to obtain a correct diagnosis.
+ For reprints and all correspondence: Kazuma Ohyashiki, First Department of Internal Medicine (Hematology/Oncology Division), Tokyo Medical University, 6–7–1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. E-mail: ohyashik{at}rr.iij4u.or.jp