Early post-transplantation lymphoproliferative disorder with central nervous system involvement and EBV infection following allogeneic hematopoietic stem cells transplantation

Abstract

Post-transplant lymphoproliferative disorders (PTLD) is a serious complication following solid organ transplantation or allogeneic hematopoietic stem cell transplantation (allo-HSCT). Pathogenesis of PTLD indicates a strong association with Epstein-Barr virus (EBV) infection. Clinical improvement is observed with reduction in immunosuppression intensity alone or administration of immuno-, chemo- and radiotherapy. We present a case of a 32-year-old man with EBV-associated PTLD as mononucleosis-like syndrome according to the 2008 World Health Organization classification with central nervous system involvement and presence of lupus anticoagulant (LA) following allo-HSCT, where decreasing the immunosuppression was not possible because of concurrent graft versus host disease (GvHD). In this situation rituximab and foscarnet in combination with immunosuppressive therapy improved PTLD and GvHD; at the same time disappearance of lupus anticoagulant was observed.