Clinical Features

The presentation of PTLDs may range from an asymptomatic state to a rapidly progressive, fulminate course with a fatal outcome.8 Hence, it is important to maintain vigilance in high-risk patients. Symptoms are varied and may be related to the EBV viral infection, B symptoms from overt lymphoma, organ dysfunction, and/or mass effect. Early symptoms may be nonspecific and may include malaise, fever, and weight loss. In children with primary EBV posttransplant, IM is the most common presentation: fever, tonsillar and adenoid hypertrophy, cervical lymphadenopathy, and hepatomegal with abnormal liver enzymes. Patients with central nervous system (CNS) involvement may present with seizures. Gastrointestinal (GI) involvement may manifest with abdominal pain, diarrhea, GI bleeding or perforation. It is important to remember that dysfunction in the organ transplanted may be an indication of involvement by PTLD. Reams et al. reported that 70% of their lung and heart-lung recipients who developed PTLD presented with thoracic organ involvement.29 Hence, any transplant patient who experiences adenopathy, mass lesions, unexplained fever or pain, weight loss, or dysfunction of the transplanted organ should be investigated for PTLD.

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