Başkent Üniversitesi Yayınları

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Subject: search.filters.subject.Epstein-Barr virus

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    Brain Tumor as an Unusual Presentation of Posttransplant Lymphoproliferative Disorder
    (Başkent Üniversitesi, 2009-03) Azarpira, Negar; Rakei, Mohamad; Torabineghad, Simin
    Objectives: Posttransplant lymphoproliferative disorder following solid organ transplant is a life-threatening form of posttransplant malignancy. Its occurrence is typically associated with Epstein-Barr virus and profound immunosuppressive therapy. We describe a case of posttransplant lympho­proliferative disorder in the brain parenchyma, 4 years after renal transplant. Case Report: A 23-year-old man was evaluated for generalized headache 4 years after receiving a deceased donor renal transplant. After initial immuno­suppression with tacrolimus and pred­nisolone, mycophenolate mofetil was added for maintenance immunosuppression. A tumor in the right occipitoparietal lobe was detected by magnetic resonance imaging and excised. Immuno­histo­chemical testing of the tumor revealed B-cell marker and Epstein-Barr virus. After surgery, the dosage of immunosuppressive drugs was reduced, and the patient was treated with chemotherapy and radiotherapy. Our patient is well after treatment. Conclusions: Reduction in immunosuppressive therapy is an important component of treatment for Epstein-Barr virus-positive posttransplant lympho­pro­liferative disorder and may lead to remission in early disease. If reduced immunosuppression fails to control early disease, cytotoxic chemotherapy, surgery and radiotherapy, antiviral therapies, and cell-based therapies are other options for treatment.
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    Posttransplant Lymphoproliferative Disease Presenting as Adrenal Insufficiency: Case Report
    (Başkent Üniversitesi, 2005-06) Khan, Abdaal; Ortiz, Jorge; Jacobson, Laura; Reich, David; Manzarbeitia, Cosme
    This is the first reported case of lymphoproliferative disease presenting with adrenal insufficiency after liver transplantation. A 38-year-old white man was admitted 8 months after transplantation for cryptogenic cirrhosis with fever (38-39°C), chills, cough, and dyspnea. His blood pressure was 100/70 mm Hg, there was pallor of the conjunctiva, and a lymph node was palpable in the left groin. Laboratory analyses revealed the following values: serum sodium concentration (112 mmol/L), potassium (5.4 mmol/L), hemoglobin (7.8 g/L), white blood cell count (7.7 x 109/L), glucose 3.9 (mmol/L), and mildly elevated liver functions. Abdominal ultrasound showed multiple hypoechoic solid-appearing lesions throughout the liver and spleen. Results of a biopsy specimen of the groin node confirmed polymorphic B-cell lymphoma. A negative Epstein-Barr virus screen before transplant became positive. The patient’s fever increased to 40°C. He subsequently developed sepsis and later, multiple organ failure. Autopsy confirmed extensive abdominal disease. The adrenal glands had been completely replaced by the tumor. Primary Epstein-Barr virus infection is associated with posttransplant lymphoproliferative disease. Replacement of the adrenal glands with a tumor produces a clinical picture of adrenal insufficiency.