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Question Id: 20932
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Question Id: 20932
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Which of the following is the most likely cause of this patient's presentation?
A. Aspergillus fumigatus
Q B. Bartonella henselae
@ C. Cryptococcus neoformans
Q D. Epstein-Barr virus
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Question Id: 20932
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Which of the following is the most likely cause of this patient's presentation?
Q A. Aspergillus fumigatus (5%)
B. Bartonella henselae (12%)
C. Cryptococcus neoformans (3%)
V@ D. Epstein-Barr virus (70%)
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Posttransplantation lymphoproliferative disorder
• Immunosuppression following solid-organ or hematopoietic stem cell
Etiology transplantation » suppressed cytotoxic T-cell immunosurveillance » Epstein-
Barr virus-encoded proteins drive unchecked B-cell growth/expansion
• Mononucleosis-like symptoms (eg, fever, night sweats, hepatosplenomegaly,
lymphadenopathy)
Manifestations
• Extranodal mass in approximately 50%
• Biopsy findings: polyclonal or monoclonal B-cell proliferation
This patient underwent solid organ transplantation and is on high-dose immunosuppressive medications due to
acute graft rejection. He subsequently developed mononucleosis-like symptoms (eg, fever, night sweats,
lymphadenopathy, hepatosplenomegaly, leukopenia) with biopsy showing large, atypical B cells completely
effacing the lymph node architecture. This constellation of findings likely indicates posttrans plantation
lymphoproliferative disorder (PTLD).
PTLD is a plasmocytic or lymphoid proliferation that occurs in the weeks or months following solid-organ or
hematopoietic stem cell transplantation. It is generally caused by proliferation of Epstein-Barr virus (EBV) in
donor or host cells due to reduced cytotoxic T-cell immunosurveillance from high dose immunosuppressive
therapy.
EBV replication promotes B-cell proliferation due to the expression of viral membrane proteins (latent membrane
protein 1/2A) that mimic B-cell antigen stimulation signals; it also promotes B-cell survival due to the expression
of viral nuclear transcription factors (EBNA-2/LP) that activate host survival genes. These virus-mediated changes
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Question Id: 20932
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Oifce of Clinical Re... zyxwvutsrqponmlkjihgfedcb
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Question Id: 20932
aPwan Previous
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Which of the following is the most likely cause of this patient's presentation?
A. Aspergillus fumigatus
Q B. Bartonella henselae
@ C. Cryptococcus neoformans
Q D. Epstein-Barr virus
, 7 Wise Money [f BML i
anking zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
PsyPal Application univers.. { AnkWeb. [} Play & Learn Chess...[ ome ]unmatched. @ UWorld - Login Q
Oifce of Clinical Re... zyxwvutsrqponmlkjihgfedcb
Item 2 of 2
Question Id: 20932
aPwan Previous
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Which of the following is the most likely cause of this patient's presentation?
Q A. Aspergillus fumigatus (5%)
B. Bartonella henselae (12%)
C. Cryptococcus neoformans (3%)
V@ D. Epstein-Barr virus (70%)
, 7 Wise Money [ BML &i Application univers... { AnkWeb. [} Play &zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA
Learn Chess...[ ome ]unmatched. Oifce of Clinical Re... @ UWorld - Login
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anking zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Q
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Question Id: 20932
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Posttransplantation lymphoproliferative disorder
• Immunosuppression following solid-organ or hematopoietic stem cell
Etiology transplantation » suppressed cytotoxic T-cell immunosurveillance » Epstein-
Barr virus-encoded proteins drive unchecked B-cell growth/expansion
• Mononucleosis-like symptoms (eg, fever, night sweats, hepatosplenomegaly,
lymphadenopathy)
Manifestations
• Extranodal mass in approximately 50%
• Biopsy findings: polyclonal or monoclonal B-cell proliferation
This patient underwent solid organ transplantation and is on high-dose immunosuppressive medications due to
acute graft rejection. He subsequently developed mononucleosis-like symptoms (eg, fever, night sweats,
lymphadenopathy, hepatosplenomegaly, leukopenia) with biopsy showing large, atypical B cells completely
effacing the lymph node architecture. This constellation of findings likely indicates posttrans plantation
lymphoproliferative disorder (PTLD).
PTLD is a plasmocytic or lymphoid proliferation that occurs in the weeks or months following solid-organ or
hematopoietic stem cell transplantation. It is generally caused by proliferation of Epstein-Barr virus (EBV) in
donor or host cells due to reduced cytotoxic T-cell immunosurveillance from high dose immunosuppressive
therapy.
EBV replication promotes B-cell proliferation due to the expression of viral membrane proteins (latent membrane
protein 1/2A) that mimic B-cell antigen stimulation signals; it also promotes B-cell survival due to the expression
of viral nuclear transcription factors (EBNA-2/LP) that activate host survival genes. These virus-mediated changes
