Epstein-Barr virus induced post-transplant lymphoproliferative disorder presenting with unilateral retinal involvement

Abstract

Purpose Post-transplant lymphoproliferative disorder (PTLD) represents a spectrum of disorders associated with Epstein Barr Virus infection in up to 80% of cases in the setting of pharmacologic immunosuppression following hematopoietic stem cell or solid organ transplantation. Ocular involvement is a rare finding in PTLD. Observation We report the case of a 38-year-old man who presented with unilateral retinal infiltrates as first manifestation of PTLD relapse. Diagnosis relied on the presence of EBV DNA in anterior chamber fluids and vitrectomy that showed the presence of a B cell clone. Systemic relapse of PTLD was detected 12 weeks after retinal findings. Treatment of ocular disease included systemic injections of rituximab and intravitreal injections of methotrexate, halting the extension of retinal infiltrates. Conclusion Ocular involvement in PTLD is rare and needs to be acknowledged because it can precede a systemic relapse of the hematological condition.

Epstein-Barr virus-positive iris diffuse large B-cell lymphoma detected by metagenomic next-generation sequencing

“…The use of immunosuppressants leads to the depletion of EBV-specific T cells and disruption of the immune system balance, which eventually causes PTLD in transplant recipients [19]. Chen reported a case of a young patient who developed an iris tumor with mutton-fat keratic precipitates after undergoing a liver transplantation surgery; anterior uveitis and iris nodules were the most common ocular manifestations of PTLDs [20,21] No study has reported a case of post-keratoplasty lymphoproliferative disorders; the clinical manifestations in our patient were not consistent with those of PTLD. Although the diagnosis of PTLD can be excluded, the negative effects of ocular immunosuppressants on the activation of intraocular viruses and the disruption of intraocular immune balance should be considered.…”