Late Onset Post Transplant Lymphoproliferative Disorder (PTLd) - A Cause for Prolonged Fever In A Patient With Biliary Anastomotic Stricture- Need To Think Beyond Cholangitis!!!

Post transplantation lymphoproliferative disorder (PTLD) is one of the less reported complications following liver transplantation (LT). With increased survival and longer followup of OLT recipients, the incidence of PTLD and especially, the number of EBV negative PTLD relative to the total number of PTLD, are increasing. Presentations can vary from a mild fever, fatigue to graft dysfunction. The incidence of PTLD was highest during the first 18 months post-OLT with cumulative incidences 0.5%, 0.9% and 1.1% at 6, 12 and 18 months, respectively and in 80% of the cases is associated with Ebstein Barr Virus (EBV) infection. Duration and type of immunosuppression, CMV and HCV infection further increases the risk for PTLD. Reduced immunosuppression is the preferred therapy in majority, however additional rituximab, adoptive immunotherapy and chemotherapy needed in selective cases. The present case is a HCV related cirrhosis, on ERCP session for biliary stricture and presented after 20 months post live donor liver transplantation with continued fever for 3 weeks and on work up diagnosed to have PTLD in absence of EBV infection. Case