Endoscopic detection of an early manifestation of EBV-related post-transplant lymphoproliferative disorder in a transplanted colon.

quires close follow-up, including endoscopic monitoring of the transplanted organ via the temporary stoma and/or anus with biopsies taken and reviewed. We present a case of post-transplant lymphoproliferative disorder (PTLD) diagnosed less than 1 month after transplantation. PTLD is a common life-threatening complication after intestinal transplantation, occurring in 13.5% of pediatric cases, and is mostly related to Epstein-Barr virus (EBV) [1,2]. A 5-year-old boy presentedwith intestinal failure secondary to microvillus inclusion disease. He received an isolated intestinal allograft combinedwith a proximal colonic allograft. To monitor for rejection and inflammation, colonoscopy and endoscopic review through the stoma were performed twice a week in the first 2 weeks and once a week after that. Lesions were detected 26 days after transplantation (●" Fig. 1a). Microscopy of the transplanted colon and the host colon revealed a polymorphous lymphocytic infiltrate in the lamina propria, non-tumor-forming (●" Fig. 1b). This PTLD consisted of CD20and CD79a-positive B cells that harbored EBV-related small RNAs (EBERs) as determined by in situ hybridization (●" Fig. 1c). The tacrolimus dose was lowered. However, 6 days later endoscopic review showed that the lesions had grown and were also present in the donor proximal ileum (●" Fig. 2a). Reduction of immunosuppressive therapy and administration of a monoclonal antibody directed against the B-cell receptor CD20 (rituximab) [3,4] induced immediate regression of the lymphomas and complete remission of the disorder within 3 months after the first dose. Six months after transplantation there was an acute episode of therapy-resistant rejection, which needed graft exploration and excision. The patient has been relisted for combined intestinal and liver transplantation. He is awaiting the retransEndoscopic detection of an early manifestation of EBV-related post-transplant lymphoproliferative disorder in a transplanted colon