EBV-associated B- and T-cell posttransplant lymphoproliferative disorders following primary EBV infection in a kidney transplant recipient

Posttransplant lymphoproliferative disorders (PTLDs) usually are of B-cell lineage and associated with Epstein-Barr virus (EBV). PTLDs of T-cell lineage are much less common and infrequently associated with EBV. We report a rare case of a girl in whom B-cell and T-cell PTLDs developed following 2 EBV-negative kidney transplants. Within 2 years of the second transplantation, the originally EBV-negative patient developed both an EBV-associated clonal B-cell PTLD involving lymph nodes and an EBV-positive T-cell PTLD involving bone marrow and liver. These proliferations occurred concurrently with evidence of primary EBV infection and high plasma viral load. The patient eventually died of multiorgan failure 5 years after the initial transplant (3 years after the second transplant). To our knowledge, only 4 cases of both Bcell and T-cell PTLDs have been reported. Only 2 cases have been proven to be monoclonal and EBVassociated, as in this case, the first following kidney transplantation. Posttransplant lymphoproliferative disorders (PTLDs) are lymphoid proliferations that develop as a consequence of immunosuppression after allogeneic solid organ or bone marrow transplantation. Both B-cell and T-cell PTLDs are