EBV Associated-Pneumonia in Patients with Post-Transplant Lymphoproliferative Disease after Hematopoietic Stem Cell Transplantation

Background. Traditionally, reactivation or infection of Epstein-Barr virus (EBV) after hematopoietic stem cell transplantation (HSCT) most often induces post-transplant lymphoproliferative disease (PTLD). In recent years, it is reported that it may manifest in patterns other than PTLD.

Methods. To investigate PTLD and PTLD accompanied by EBV associated- pneumonia among 323 patients after HSCT and discribe the clinical manifestation of PTLD accompanied by EBV associated-pneumonia.

Results. Seven cases of PTLD with primary presentation as extravisceral lymphoid tissue were identified. Five cases were diagnosed of CD20+ diffuse large B-cell lymphoma, 1 cases CD20+ polymorphic B-cell hyperplasia and 1 case CD3+CD45RO+ peripherial T-cell lymphoma-unspecified. Six patients were associated with EBV and 1 case was not in 7 cases of PTLD. Three patients were diagnosed of EBV associated-pneumonia and chest computed tomography revealed multifocal patchy and diffuse ground-glass attenuation in both lungs. EBV-DNA was positive in bronchoalveolar lavage fluid. There were mainly CD3+ T cells with the absence of CD19+ and CD20+ B cells in cytology analysis of BAL fluid. Lung biopsy showed that patients had interstitial and intra-alveolus infiltrates of main CD3+ T cells and part of CD68+ macrophages without CD19+ and CD20+ B cells. The patients with PTLD accompanied by EBV associated-pneumonia had hyperpyrexia and dyspnea. The diseases aggravated rapidly and eventually all died within two weeks since the onset of PTLD.

Conclusion. It is not rare for EBV associated-PTLD accompanied by EBV associated- pneumonia after HSCT. Cytology of BAL fluid and lung biopsy may help to the diagnosis.