Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2021; 9(2): 469-475
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.469
Epstein-Barr virus-associated monomorphic post-transplant lymphoproliferative disorder after pediatric kidney transplantation: A case report
Zhen Wang, Yang Xu, Jie Zhao, Ying-Xin Fu
Zhen Wang, Yang Xu, Jie Zhao, Ying-Xin Fu, Department of Kidney Transplantation, Tianjin First Central Hospital, Tianjin 300192, China
Author contributions: Wang Z and Fu YX contributed equally to this work; Fu YX performed the kidney transplant, guided the diagnosis and treatment of the patient, proposed the article and directed the writing of the article; Xu Y collected the clinical data; Wang Z analyzed the data and wrote the manuscript; Wang Z, Xu Y, and Zhao J participated in the diagnosis and treatment of the patient; All authors have read and approved the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All study participants had no potential conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Xin Fu, MD, PhD, Chief Doctor, Surgeon, Department of Kidney Transplantation, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. fuyingxin@vip.163.com
Received: August 27, 2020
Peer-review started: August 27, 2020
First decision: November 3, 2020
Revised: November 18, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 16, 2021
Abstract
BACKGROUND

Post-transplant lymphoproliferative disease (PTLD) is the most common malignant tumor that occurs after kidney transplantation in children, and is associated with Epstein-Barr virus (EBV).

CASE SUMMARY

We report a case of PTLD that occurred in a 17-year-old female patient at 5 mo post-transplant. The first symptom was abdominal pain accompanied by fever, nausea, and vomiting. EBV-associated monomorphic PTLD with multiple abdominal nodules was diagnosed by pathology, clinical manifestations, imaging results, and the presence of EB-DNA. After successful treatment with rituximab, the abdominal nodules in the spleen and liver disappeared.

CONCLUSION

Early pathological biopsy to confirm the diagnosis is critical to treatment and prognosis. Reducing immunosuppression and rituximab therapy are effective methods for treating PTLD, but need to be initiated as early as possible.

Keywords: Post-transplant lymphoproliferative disorder, Epstein-Barr virus, Kidney transplantation, Case report, Biopsy, Calcineurin inhibitors

Core Tip: Post-transplant lymphoproliferative disease (PTLD) is related to Epstein-Barr virus infection, but early onset and monomorphic PTLD in childhood kidney transplantation is rare. This case suggests that virological evaluation must be strengthened before and after kidney transplantation in children, and early pathological biopsy to confirm the diagnosis is critical to treatment and prognosis. Rituximab therapy combined with adjusting the immunosuppressive regimen are effective in pediatric kidney transplantation.