EBV post transplantation lymphoproliferative disease-associated pneumomediastinum in a pediatric patient with long-lasting low loads of plasma EBV-DNA positivity

摘要

We report a patient with extensive chronic-GVHD (c-GVHD) after BMT in whom pneumomediastinum and subcutaneous emphysema developed as the first sign of EBV post transplantation lymphoproliferative disease (PTLD) after long-lasting low loads of plasma EBV-DNA positivity.A 3-year-old boy in second CR for T-cell leukemia received BMT from an HLA-A allele-mismatched unrelated donor. The course was complicated by extensive c-GVHD disease of the skin and gastrointestinal tract, for which he was treated with CsA and prednisolone. Four months after BMT, he was admitted because of neutropenic fever. Shortly thereafter, he developed dyspnea, tachypnea and oxygen dependency. A chest X-ray revealed pneumomediastinum (Figure 1, arrow heads) with subcutaneous emphysema (Figure 1, black arrows) and prominent mediastinal masses (Figure 1, white arrow), suspected to be lymphomas. The weekly monitoring for EBV by PCR in plasma had been positive for 8 weeks. It showed relatively low loads ranging from 50 to 3600 copies/mlwithout any symptoms. In the weeks before theevent, loads spontaneously decreased to 100-300 copies/ml, and at the time of the event, the plasma viral load was 265 copies/ml.