Primary effusion lymphoma of the pleural space: Report of a rare complication of cardiac transplant with review of the literature

Kugasia, Irfanali R; Kumar, Arun; Khatri, Akshay; Saeed, Faisal; Islam, Humayun; Epelbaum, Oleg

doi:10.1111/tid.13005

Cited by 14 publications

(33 citation statements)

References 31 publications

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“…Ever since its first report in patients with advanced HIV infection , PEL has been subsequently diagnosed in HIV‐uninfected patients. Many of these HIV‐uninfected cases were identified in HHV‐8‐endemic regions, or were found in recipients of organ transplantation undergoing immunosuppressive therapy . Sporadic cases have been reported in patients with neither HIV infection nor transplantation history from other regions including Japan and South Korea .…”

Section: Discussionmentioning

confidence: 99%

Human herpesvirus 8‐related primary effusion lymphoma in four HIV‐uninfected patients without organ transplantation

Kuo

Chang

et al. 2019

Respirology Case Reports

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Primary effusion lymphoma (PEL) is a rare subtype of non‐Hodgkin's lymphoma. PEL is closely related in pathogenesis to human herpesvirus 8 (HHV‐8) and typically occurs in patients with significant immunodeficiency. Cases of PEL in patients without either HIV infection or transplantation have been reported from HHV‐8‐endemic areas, but very rarely from the Asia‐Pacific region. In this case series, we describe the clinical and immunohistochemical presentations of four patients in southern Taiwan who were diagnosed with HHV‐8‐related PEL. All four patients were HIV‐negative and had not received organ transplantation. To our knowledge, this is the first authentic report of HIV‐unrelated PEL from the ethnically Chinese population. Considering the non‐specific clinical manifestations, the pivotal roles of specific assays for correct diagnosis, and the dismal prognosis of PEL, it is important for clinicians to include PEL as one of the differential diagnosis when approaching HIV‐uninfected patients with unexplained exudative body cavity effusion.

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Section: Discussionmentioning

confidence: 99%

Human herpesvirus 8‐related primary effusion lymphoma in four HIV‐uninfected patients without organ transplantation

Kuo

Chang

et al. 2019

Respirology Case Reports

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“…In 2/4 cases, KS preceded PEL, developing 5 months after transplant [2,4] and in one of these, KS initially progressed despite chemotherapy and reduction of immunosuppressive treatment (mycophenolate mofetil stopping and tacrolimus plus prednisone reduction); then KS partial remission was obtained with rapamycin administration and tacrolimus stopping [4]. In 1/4 cases, KS was discovered at post-mortem examination [11], whereas in 1/4 cases, KS occurred before transplant and was successfully treated with radiotherapy, but it recurred at PEL diagnosis [12]. In the case reported by Christenson, the patient developed squamous cell carcinoma of head and neck and was treated with surgery plus chemotherapy and radiotherapy [9].…”

Section: Malignancies Other Than Pelmentioning

confidence: 99%

“…In 1/13 cases, only antiviral treatment with cidofovir was used [4]. Changes in the immunosuppressive treatment were performed at PEL diagnosis in 4/13 cases as follows: 1/4: tacrolimus was changed to sirolimus (rapamycin) resulting in undetectable HHV8 DNA blood level [12]; 1/4: cyclosporine reduction [2]; 1/4: cyclosporine reduction plus azathioprine stopping [3]; 1/4: cyclosporine and azathioprine stopping plus introduction of rapamycin [5]. In 1/13 cases, tacrolimus was changed to rapamycin due to altered renal function, 1 month prior PEL diagnosis and then rapamycin was continued [9].…”

Section: Treatment and Outcomementioning

confidence: 99%

Primary Effusion Lymphoma Occurring in the Setting of Transplanted Patients: A Systematic Review of a Rare, Life-Threatening Post-Transplantation Occurrence

Zanelli

Sanguedolce

Zizzo

et al. 2021

Preprint

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Background: Primary effusion lymphoma is a rare, aggressive large B-cell lymphoma strictly linked to infection by Human Herpes virus 8/Kaposi sarcoma-associated herpes virus. In its classic form, it is characterized by body cavities neoplastic effusions without detectable tumor masses. It often occurs in immunocompromised patients, such as HIV-positive individuals. Primary effusion lymphoma may affect HIV-negative elderly patients from Human Herpes virus 8 endemic regions. So far, rare cases have been reported in transplanted patients. The purpose of our systematic review is to improve our understanding of this type of aggressive lymphoma in the setting of transplantation, focusing on epidemiology, clinical presentation, pathological features, differential diagnosis, treatment and outcome. The role of assessing the viral serological status in donors and recipients is also discussed.Methods: Based on the PRISMA guidelines, we carried out a systematic search on PubMed/MEDLINE, Web of Science, Scopus, EMBASE and Cochrane Library using the search terms “primary effusion lymphoma” and “post-transplant”. Results: Our search identified 13 cases of post-transplant primary effusion lymphoma, predominantly in solid organ transplant recipients (6 kidney, 3 heart, 2 liver and 1 intestine), with only one case after allogenic bone marrow transplantation. Long-term immunosuppression is important in post-transplant primary effusion lymphoma commonly developing several years after transplantation. Kaposi Sarcoma occurred in association with lymphoma in 4 cases of solid organ recipients. The lymphoma showed the classical presentation with body cavity effusions in absence of tumor masses in 10 cases; 2 cases presented as solid masses, lacking effusions and one case as effusions associated with multiple organ involvement. Primary effusion lymphoma occurring in the setting of transplantation was more often Epstein Barr-virus negative. The prognosis was poor. In addition to chemotherapy, reduction of immunosuppressive treatment, was generally attempted.Conclusions: Primary effusion lymphoma is a rare, but often fatal post-transplant complication. Its rarity and the difficulty in achieving the diagnosis may lead to miss this complication. Clinicians should suspect primary effusion lymphoma in transplanted patients, presenting generally with unexplained body cavity effusions, although rare cases with solid masses are described.

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“…Common clinical manifestations of MCD include fevers, pancytopenia, lymphadenopathy, elevated inflammatory markers and splenomegaly [136]. The diagnosis of PEL should be considered in a patient presenting with effusions in relation to serosal surfaces of the body (pericardium, pleural, peritoneal) [137,138]. Concomitant occurrence of multiple disease manifestations of HHV-8 has also been reported in transplant recipients including KS and MCD [139][140][141], and KS, MCD and HLH [142].…”

Section: Clinical Manifestations Of Hhv-8: Oncogenic and Non-oncogenimentioning

confidence: 99%

Non-CMV Viral Infections Following Solid-Organ Transplantation – Focus on Human T-Cell Lymphotropic Virus Type-1 and Human Herpesviruses-6,-7 and -8

Oikonomou¹,

Taimur²

2019

obm transplant

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In non-endemic regions of the world, human T-cell lymphotropic virus type-1 (HTLV-1) is an uncommon pathogen in the transplant host, but can be associated with significant morbidity and mortality. Careful assessment for risk factors, targeted screening and heightened awareness of the clinical presentation of HTLV-1 associated disease is necessary for timely recognition and management in the transplant host. The use of antiretroviral agents in the management of symptomatic disease due to HTLV-1 remains controversial. Human herpesvirus-6 (HHV-6) has long been recognized as a pathogen in the transplant host however, establishing pathogenicity remains a challenge in clinical situations. Chromosomally integrated HHV-6 has been reported in ~1% of the solid-organ and allogeneic stem cell transplant population; and is often mistaken for active infection. Increased recognition of this entity is needed to avoid unnecessary use of antiviral medications. Current guidelines recommend against screening and treatment of asymptomatic HHV-6 infection in the solid-organ transplant host. Human herpesvirus-7 (HHV-7) is often diagnosed as co-infection with other beta-herpesviruses, but pathogenicity is less clear. There continues to be no clinical syndrome solely attributable to HHV-7. Human

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Primary effusion lymphoma of the pleural space: Report of a rare complication of cardiac transplant with review of the literature

Cited by 14 publications

References 31 publications

Human herpesvirus 8‐related primary effusion lymphoma in four HIV‐uninfected patients without organ transplantation

Human herpesvirus 8‐related primary effusion lymphoma in four HIV‐uninfected patients without organ transplantation

Primary Effusion Lymphoma Occurring in the Setting of Transplanted Patients: A Systematic Review of a Rare, Life-Threatening Post-Transplantation Occurrence

Non-CMV Viral Infections Following Solid-Organ Transplantation – Focus on Human T-Cell Lymphotropic Virus Type-1 and Human Herpesviruses-6,-7 and -8

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