Lung Cancer: Student/Resident Case Report Poster - Lung Cancer II |

Primary Effusion Lymphoma in Solid Organ Transplant Recipient FREE TO VIEW

Omar Ahmed, MD; Srihari Veeraraghavan, MD
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Emory University, Decatur, GA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):758A. doi:10.1016/j.chest.2016.08.853
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Immunosuppression in patients with solid organ transplants is a risk factor for secondary malignancies.. The epidemiology differs from other immunocompromised conditions (i.e. AIDS). This is a case of primary effusion lymphoma in a solid organ transplant recipient on immunosuppression.

CASE PRESENTATION: A 66 year old male with history of diabetes and orthotopic liver transplant 1 year ago secondary to NASH cirrhosis was admitted from clinic for two weeks of worsening dyspnea on exertion and nonproductive cough that had acutely worsened over past two days. He had been having low-grade fevers and denied sick contacts. His medications included tacrolimus and mycophenolate mofetil. His exam was concerning for right-sided dullness on percussion with decrease breath sounds. Labs were unremarkable, but chest x-ray showed a new right sided pleural effusion. Thoracentesis was performed yielding a cloudy exudative effusion, with 84% atypical cells with flow cytometry showing an 18% clonal population of cells positive for low-density CD 45. Bone marrow biopsy showed a normocellular bone marrow without signs of underlying hematologic malignancy. HHV-8 staining of tumor cells was also positive. The patient was diagnosed with primary effusion lymphoma. Chemotherapy was initiated as inpatient with CHOP. He underwent three cycles but continued to have recurrent pleural effusions. Six months after diagnosis, the patient presented with septic shock and multi-organ failure and subsequently transitioned to hospice.

DISCUSSION: Primary effusion lymphoma (PEL), as diagnosed in our patient, is a form of B cell, Non-Hodgkin, primary (body cavity) lymphoma that is most commonly associated with AIDS with an incidence 1-4% of AIDS patients [1]. It has rarely been described in solid organ transplant recipients [2] Infection with HHV8 is thought to play an important role in its pathogenesis [3] as well as infection with EBV. Even with treatment, PEL is associated with a poor prognosis and a median survival of only 6 months after diagnosis.

CONCLUSIONS: This case shows a rare presentation of primary effusion lymphoma in the setting of Immunosuppression in organ transplant recipient from the development of an HHV-8 infection.

Reference #1: Simonelli C, S.M., Cinelli R, Talamini R, Tedeschi R, Gloghini A, Vaccher E, Carbone A, Tirelli U, Clinical features and outcome of primary effusion lymphoma in HIV-infected patients: a single-institution study. J Clin Oncol, 2003. 21(21): p. 3948.

Reference #2: Jones D, B.M., Kaye KM, Gulizia JM, Winters GL, Fletcher J, Scadden DT, Aster JC, Primary-effusion lymphoma and Kaposi's sarcoma in a cardiac-transplant recipient. N Engl J Med, 1998. 339(7): p. 444.

Reference #3: Cesarman E, C.Y., Moore PS, Said JW, Knowles DM, Kaposi's sarcoma-associated herpesvirus-like DNA sequences in AIDS-related body-cavity-based lymphomas. N Engl J Med, 1995. 332(18): p. 1186.

DISCLOSURE: The following authors have nothing to disclose: Omar Ahmed, Srihari Veeraraghavan

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