Epstein-Barr virus-associated post-transplant lymphoproliferative disorder presenting with skin involvement after CD34-selected autologous peripheral blood stem cell transplantation

We report a case of Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorder (PTLD) after CD34-selected autologous peripheral blood stem cell transplantation (PBSCT). A 54-year-old woman with multiple myeloma underwent CD34-selected autologous PBSCT. The patient’s post-transplantation course was complicated by fever, pancytopenia and CMV antigenemia. On day 128 post PBSCT, a skin biopsy from an erythematous nodule on the right anterior chest revealed a deep dermal infiltrate of atypical CD20 and CD79a-positive B-cells with centroblastic large cell morphology. EBV reactivation was confirmed by immnohistochemistry, in situ hybridization and Southern blot analysis. These findings represent monomorphic PTLD having pathological features of a large cell-type B-cell lymphoma. Bone marrow aspiration also demonstrated hemophagocytic syndrome (HPS), accompanied with infiltration of EBV-positive B-cells. Despite treatment with rituximab and hydroxyurea, the patient died 155 days after transplantation.