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EBV-Associated LPD Non-Transplant — SCE Infectious Diseases MCQ

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HardImmunocompromised HostEBV-Associated LPD Non-TransplantSCE Infectious Diseases

A 40-year-old woman on long-term immunosuppression for lupus nephritis is diagnosed with EBV-positive post-transplant-like lymphoproliferative disorder (PTLD-like). She has not had a transplant. What is the initial management approach?

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Correct answer: E — Reduction of immunosuppression to allow EBV-specific immune reconstitution

EBV-driven lymphoproliferative disorders can occur in non-transplant immunosuppressed patients (iatrogenic immunodeficiency-associated LPD, now classified by WHO). The initial management is reduction of immunosuppression, which may alone lead to regression by restoring EBV-specific T-cell immunity. If reduction of immunosuppression does not achieve regression, or if the disease is aggressive/high-grade, Rituximab ± chemotherapy is the next step. Aciclovir and other antivirals do not affect EBV-driven lymphoproliferation as the viral thymidine kinase is not expressed in latently infected cells.

Reference: BSH 2023 – LPD in immunosuppression; WHO 2024 – Haematolymphoid tumour classification