Abstract

OBJECTIVES
Posttransplant lymphoproliferative disorder (PTLD) is a well-recognized complication of solid organ transplantation and commonly affects upper airway lymphoid tissue. Tracheal and laryngeal involvement in patients with PTLD, however, is rare. We present one such case.
METHODS
We report the case of a patient with recurrent PTLD involving the larynx and trachea and describe the presentation, evaluation, management, and outcome.
RESULTS
An 11-year-old boy who underwent bilateral nephrectomy and renal transplantation as an infant was admitted to the hospital with chronic cough, fever, stridor, and dyspnea. His post-transplantation course was complicated by PTLD in cervical lymph nodes at 9 years of age that was successfully treated with chemotherapy. A computed tomographic scan during his present admission revealed supraglottic swelling, a distal tracheal mass, and paratracheal lymph node enlargement. The patient underwent laryngoscopy and bronchoscopy with biopsy specimens taken from the right laryngeal ventricle and distal trachea. Pathologic examination yielded a diagnosis of Epstein-Barr virus-positive PTLD. The patient was treated with chemotherapy, which resulted in resolution of the airway lesions, as seen on repeat bronchoscopy.
CONCLUSIONS
This is the first report, to our knowledge, of recurrent PTLD involving simultaneous lesions in the larynx and the trachea. PTLD in the head and neck can present as lymphoid hypertrophy, airway obstruction, stridor, or cough. A high degree of clinical suspicion is essential for prompt diagnosis of this life-threatening complication.

Links

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Authors

Banks CA, Meier JD, Stallworth CR, White DR

Institution

Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.

Source

The Annals of otology, rhinology, and laryngology 121:5 2012 May pg 291-5

MeSH

Airway Obstruction
Antibodies, Monoclonal, Murine-Derived
Antineoplastic Combined Chemotherapy Protocols
Bronchoscopy
Child
Cyclophosphamide
Epstein-Barr Virus Infections
Glucocorticoids
Herpesvirus 4, Human
Humans
Immunocompromised Host
Immunoglobulins, Intravenous
Immunosuppressive Agents
Kidney Transplantation
Larynx
Lymphoproliferative Disorders
Male
Nephrectomy
Recurrence
Trachea
Treatment Outcome

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

22724273