Pulmonary Vascular Disease: Fellow Case Report Slide: Pulmonary Critical Care Disorders: Think Twice |

Bladder PTLD: First Reported Case of Post-Transplant Lymphoproliferative Disorder (PTLD) in the Bladder in a Lung Transplant Recipient FREE TO VIEW

Harpreet Grewal, MD; Arunachalam Ambalavanan, MD; Eric Hsi, MD; Olufemi Akindipe, MD; Marie Budev, DO
Author and Funding Information

Cleveland Clinic Foundation, Parma, OH

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

Chest. 2016;150(4_S):1138A. doi:10.1016/j.chest.2016.08.1248
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SESSION TITLE: Fellow Case Report Slide: Pulmonary Critical Care Disorders: Think Twice

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 23, 2016 at 10:45 AM - 12:00 PM

INTRODUCTION: Post transplant lymphoproliferative disorder (PTLD) occurs in 5% of patients. PTLD has been categorized as monomorphic occurring early and polymorphic mostly occurring as a late presentation (greater than 1-year post transplant). Epstein Barr virus (EBV) is believed to be an essential factor in pathogenesis of PTLD. Our case is unique because it is the first reported case of bladder PTLD being reported in the lung transplant population.

CASE PRESENTATION: This is a case of a 62-year-old female with 70 pack years smoking history who received a bilateral lung transplant for COPD in 2010. Patient presented with fevers, left sided flank pain and increased urination with foul-smelling urine. She was noted to have leukocytosis and mild hyponatremia. A CT of abdomen and pelvis revealed a non-obstructing right kidney stone along with irregular and nodular bladder wall thickening suspicious for urothelial neoplasm. Cystoscopy revealed multiple bladder masses and biopsy demonstrated non-Hodgkin lymphoma consistent with PTLD, monomorphic diffuse large B-cell lymphoma which was EBV negative, positive for CD 10, CD 20, BCL-6, MUM1, and c-MYC (40%). Whole body PET scan revealed an FDG avid prevascular lymph node in the chest; consistent with Stage IV PTLD. Patient received treatment with six cycles of rituximab- cyclophosphamide (Cytoxan), Adriamycin (hydroxydoxorubicin), vincristine (oncovin) and prednisone (R-CHOP) with curative intent and a reduction in immunosuppressive therapy.

DISCUSSION: Here we present the first case of PTLD involvement of bladder in a lung transplant recipient. PTLD, in lung transplant population has been described in the gut, respiratory tract, skin, liver, kidney but not in the bladder. Our strategy using CHOP as the treatment of PTLD in solid organ transplantation was also the treatment of choice along with immunosuppressive reduction for this patient.

CONCLUSIONS: This is the first reported case of monomorphic, EBV negative bladder PTLD in a lung transplant recipient. Although PTLD is uncommon, this case reminds transplant physicians caring for such patients that it can involve any extrapulmonary organ.

Reference #1: Kremer BE, et. al. PTLD after lung transplantation. J Heart Lung Transplant. 2012 Mar;31(3):296-304.

Reference #2: Thomas de Montpréville V et. al. Lymphoproliferative Disorders after Lung Transplantation. Respiration. 2015;90(6):451-9.

Reference #3: Trappe R et. al. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell PTLD. Lancet Oncol. 2012 Feb;13(2):196-206.

DISCLOSURE: The following authors have nothing to disclose: Harpreet Grewal, Arunachalam Ambalavanan, Eric Hsi, Olufemi Akindipe, Marie Budev

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