Suzuki Megumi, Kawashima Ichiro, Suzuki Jun, Kumagai Takuma, Koshiishi Megumi, Nakajima Kei, Kirito Keita
Department of Hematology/Oncology, University of Yamanashi.
Rinsho Ketsueki. 2021;62(3):170-175. doi: 10.11406/rinketsu.62.170.
Post-transplant lymphoproliferative disorder (PTLD) usually develops with systemic symptoms, such as fever, generalized lymphadenopathy, and elevation in the lactate dehydrogenase level. Here, we present the case of a 65-year-old female patient with PTLD localized to the colon; the patient only had mild diarrhea without systemic symptoms. She had myelodysplastic syndrome and was treated with cord blood transplantation (CBT). She had a past medical history of sigmoid colon cancer treated with colonosectomy and adjuvant chemotherapy. After CBT, she achieved complete remission and was discharged after 60 days. Further, 79 days after CBT, she presented with abdominal pain. Computed tomography scan revealed adhesive ileus. The abdominal pain was resolved in 1 day with conservative treatment, however, mild diarrhea persisted. Therefore, we performed colonoscopy and found multiple ulcerative lesions in the upper colon. A pathological examination revealed PTLD. Furthermore, elevation of EBV-DNA in the blood was also confirmed. There was no detectable lesion on positron emission tomography-computed tomography (PET-CT) outside the colon; thus, we diagnosed PTLD localized into the colon that was successfully treated with rituximab. Our present experience suggests that it might be important to perform endoscopy and monitoring of EBV-DNA for early detection of PTLD, especially localized in the gastrointestinal tract.
移植后淋巴细胞增生性疾病(PTLD)通常会出现全身症状,如发热、全身淋巴结肿大以及乳酸脱氢酶水平升高。在此,我们报告一例65岁女性PTLD患者,病变局限于结肠;该患者仅有轻度腹泻,无全身症状。她患有骨髓增生异常综合征,接受了脐血移植(CBT)治疗。她既往有乙状结肠癌病史,接受过结肠切除术和辅助化疗。CBT后,她实现了完全缓解,并在60天后出院。此外,CBT后79天,她出现腹痛。计算机断层扫描显示粘连性肠梗阻。经保守治疗,腹痛在1天内缓解,但轻度腹泻持续存在。因此,我们进行了结肠镜检查,发现结肠上段有多个溃疡性病变。病理检查显示为PTLD。此外,血液中EBV - DNA升高也得到证实。在结肠外的正电子发射断层扫描 - 计算机断层扫描(PET - CT)上未发现可检测到的病变;因此,我们诊断为局限于结肠的PTLD,并成功用利妥昔单抗进行了治疗。我们目前的经验表明,进行内镜检查和监测EBV - DNA对于早期检测PTLD可能很重要,尤其是局限于胃肠道的PTLD。