RAPIDLY PROGRESSIVE POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDER AFTER LUNG TRANSPLANTATION

TYPE: Case Report TOPIC: Transplantation INTRODUCTION: Posttransplant lymphoproliferative disorder (PTLD) after lung transplantation occurs due to immunosuppressant therapy, which limits antiviral host immunity and permits Epstein-Barr viral (EBV) replication B cell transformation. CASE PRESENTATION: A 67-year-old female, bilateral transplant recipient (07/2019) with a history of idiopathic pulmonary fibrosis developed rapidly progressive PTLD in the early postoperative course. DISCUSSION: At 6-months transplant, chest radiographs revealed left hilar fullness; subsequent CT showed evidence fluid fissure, no obvious lymphadenopathy. Chest performed just two weeks later mass measuring 6.1 × 2.7 cm encasement main artery partial collapse bronchus. Endobronchial ultrasound-guided biopsies led diagnosis CD20-positive, EBV-positive PTLD. Initial PET scan demonstrated multiple lymph nodes, largest 2.2 2.8 cm. Immunosuppression was reduced, because involved only one area an EBV-mismatched recipient, she qualified for single-agent rituximab once/week. Unfortunately, repeat imaging five doses significant disease progression. She required bronchoscopy tumor debulking necrotic, endobronchial occluding up one-half lower lobe started R-mini-CHOP, three cycles chemotherapy, complete response observed on most recent PET/CT scan. CONCLUSIONS: may progress quickly, as initial showing collection advanced into mass. Reduction immunosuppression, anti-CD20 biologic chemotherapy refractory remains appropriate treatment paradigm. DISCLOSURE: Nothing declare. KEYWORD: Post-lung