99. A 47-year-old man with a history of a heart-lung transplant 3 years ago complains of fever, malaise, and abdominal pain. The patient has been taking cyclosporine for immunosuppression. Physical examination reveals an abdominal mass. A CT-guided biopsy of the mass shows atypical lymphocytes that are positive for latent membrane proteins of Epstein-Barr virus (EBV). What is the most likely diagnosis?
Acute suppurative lymphadenitis
Posttransplant lymphoproliferative disorder
Answer : D Posttransplant lymphoproliferative disorder
PTLD results from immunosuppression and is often associated with EBV infection. In most cases, the disease is an EBV-driven, monoclonal, lymphocyte proliferation with variable morphology.
The incidence of PTLD parallels the extent of immunosuppression. In this connection, liver transplant recipients have a higher incidence of PTLD than do patients who receive kidney transplants.
Burkitt lymphoma has been related to EBV infection but is not a complication of immunosuppression.