Post-Transplant Lymphoproliferative Disorder Presenting as a Gastrointestinal Fistulous Tract in a Heart Transplant Recipient: Case Report and Literature Review.

Nour Hasan, Ramia Zakhour, Luz Helena Gutierrez Sanchez, Audrey R Lloyd, Geling Li, Clara L Ortiz, Cecelia Hutto

Journal: Transplantation proceedings 2024;56(9):2084-2091

PMID: 39214719

Full Text on Elsevier Science View on PubMed

Abstract

We present a challenging case of Epstein-Barr virus-related isolated small bowel post-transplant lymphoproliferative disorder (PTLD) in a pediatric heart transplant recipient presenting as recurrent gastrointestinal (GI) bleeding and subsequently a GI fistulous tract with associated intra-abdominal abscess. Diagnosis was not confirmed until exploratory laparoscopy was performed, with excision of the fistulous tract revealing evidence of PTLD on pathology. Early diagnosis of GI-PTLD remains a challenge, especially if isolated in the small intestine. Diagnosis may rely on positron emission tomography/ computed tomography scan (PET/CT) or invasive intervention to obtain appropriate tissue samples for pathology diagnosis.

Address: Division of Pediatric Infectious Diseases, Department of Pediatrics, Saint Louis University, St. Louis, Missouri. Electronic address: [email protected].; Division of Pediatric Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.; Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Alabama at Birmingham, Birmingham, Alabama; Children's of Alabama, Birmingham, Alabama.; Children's of Alabama, Birmingham, Alabama; Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.; Children's of Alabama, Birmingham, Alabama; Department of Pathology and Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama.; Children's of Alabama, Birmingham, Alabama; Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.

DOI: 10.1016/j.transproceed.2024.07.008

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MeSH Terms: Humans, Heart Transplantation, Lymphoproliferative Disorders, Male, Epstein-Barr Virus Infections, Postoperative Complications, Intestinal Fistula