• Mononucleosis-like symptoms (eg, fever, night sweats, hepatosplenomegaly,
lymphadenopathy)
Manifestations
• Extranodal mass in approximately 50%
• Biopsy findings: polyclonal or monoclonal B-cell proliferation
This patient underwent solid organ transplantation and is on high-dose immunosuppressive medications due to
acute graft rejection. He subsequently developed mononucleosis-like symptoms (eg, fever, night sweats,
lymphadenopathy, hepatosplenomegaly, leukopenia) with biopsy showing large, atypical B cells completely
effacing the lymph node architecture. This constellation of findings likely indicates posttrans plantation
lymphoproliferative disorder (PTLD).
PTLD is a plasmocytic or lymphoid proliferation that occurs in the weeks or months following solid-organ or
hematopoietic stem cell transplantation. It is generally caused by proliferation of Epstein-Barr virus (EBV) in
donor or host cells due to reduced cytotoxic T-cell immunosurveillance from high dose immunosuppressive
therapy.
EBV replication promotes B-cell proliferation due to the expression of viral membrane proteins (latent membrane
protein 1/2A) that mimic B-cell antigen stimulation signals; it also promotes B-cell survival due to the expression
of viral nuclear transcription factors (EBNA-2/LP) that activate host survival genes. These virus-mediated changes
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