Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Presentation and management of post-allogeneic transplantation EBV-positive mucocutaneous ulcer

Bone Marrow Transplantation volume 51, pages 300–302 (2016)Cite this article

Subjects

Post-transplant lymphoproliferative disorders (PTLD) are a heterogeneous group of lymphoid neoplasms occurring as a result of immunosuppression following both solid organ and hematopoietic cell transplant (HCT). PTLD have a variety of presentations and only recently have been described to present as an isolated EBV-associated mucocutaneous ulceration (MCU). To our knowledge, only one case of PTLD manifesting as EBV+ MCU has been reported following HCT.1 Here we report a second case and provide diagnostic consideration and management recommendations.

A 64-year-old Caucasian male with advanced mantle cell lymphoma underwent high-dose therapy (HDT) and autologous HCT in first remission. Three years after high-dose therapy, the patient developed therapy-related myelodysplastic syndrome. He subsequently underwent a HLA-identical sibling allogeneic HCT after reduced intensity conditioning with fludarabine and busulfan. GVHD prophylaxis consisted of methotrexate and tacrolimus.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

References

  1. Dojcinov SD, Venkataraman G, Raffeld M, Pittaluga S, Jaffe ES . EBV positive mucocutaneous ulcer—a study of 26 cases associated with various sources of immunosuppression. Am J Surg Pathol 2010; 34: 405–417.

    Article  PubMed  PubMed Central  Google Scholar 

  2. The International Agency for Research on Cancer WHO Classification of Tumours of Haematopoietic and Lymphoid Tissue. World Health Organization: Lyon, France, 2008.

  3. Landgren O, Gilbert ES, Rizzo JD, Socie G, Banks PM, Sobocinski KA et al. Risk factors for lymphoproliferative disorders after allogeneic hematopoietic cell transplantation. Blood 2009; 113: 4992–5001.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Baker KS, DeFor TE, Burns LJ, Ramsay NK, Neglia JP, Robison LL . New malignancies after blood or marrow stem-cell transplantation in children and adults: incidence and risk factors. J Clin Oncol 2003; 21: 1352–1358.

    Article  PubMed  Google Scholar 

  5. Curtis RE, Travis LB, Rowlings PA, Socie G, Kingma DW, Banks PM et al. Risk of lymphoproliferative disorders after bone marrow transplantation: a multi-institutional study. Blood 1999; 94: 2208–2216.

    CAS  PubMed  Google Scholar 

  6. Cho YU, Chi HS, Jang S, Park SH, Park CJ . Pattern analysis of Epstein-Barr virus viremia and its significance in the evaluation of organ transplant patients suspected of having posttransplant lymphoproliferative disorders. Am J Clin Pathol 2014; 141: 268–274.

    Article  PubMed  Google Scholar 

  7. Elad S, Meyerowitz C, Shapira MY, Glick M, Bitan M, Amir G . Oral posttransplantation lymphoproliferative disorder: an uncommon site for an uncommon disorder. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105: 59–64.

    Article  PubMed  Google Scholar 

  8. Hart M, Thakral B, Yohe S, Balfour HH Jr, Singh C, Spears M et al. EBV-positive mucocutaneous ulcer in organ transplant recipients: a localized indolent posttransplant lymphoproliferative disorder. Am J Surg Pathol 2014; 38: 1522–1529.

    Article  PubMed  Google Scholar 

  9. Dojcinov SD, Venkataraman G, Pittaluga S, Wlodarska I, Schrager JA, Raffeld M et al. Age-related EBV-associated lymphoproliferative disorders in the Western population: a spectrum of reactive lymphoid hyperplasia and lymphoma. Blood 2011; 117: 4726–4735.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Moran NR, Webster B, Lee KM, Trotman J, Kwan YL, Napoli J et al. Epstein Barr virus-positive mucocutaneous ulcer of the colon associated Hodgkin lymphoma in Crohn's disease. World J Gastroenterol 2015; 21: 6072–6076.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    A A Nelson

  2. Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA

    A M Harrington & S Kroft

  3. Department of Medicine, Saint Francis Hospital, Evanston, IL, USA

    M A Dahar

  4. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    M Hamadani & B Dhakal

Authors
  1. A A Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A M Harrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Kroft
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M A Dahar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M Hamadani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B Dhakal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B Dhakal.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nelson, A., Harrington, A., Kroft, S. et al. Presentation and management of post-allogeneic transplantation EBV-positive mucocutaneous ulcer. Bone Marrow Transplant 51, 300–302 (2016). https://doi.org/10.1038/bmt.2015.245

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2015.245

This article is cited by

Search

Advanced search

Quick links