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PTLD — RACP Adult Medicine MCQ

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ModerateHaematologyPTLDRACP Adult Medicine

A 45-year-old liver transplant recipient (3 years post-transplant) develops cervical and mediastinal lymphadenopathy with B symptoms. Biopsy shows polymorphic B-cell proliferation positive for EBV (EBER staining). CD20 is positive. EBV viral load is markedly elevated. What is the most likely diagnosis?

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Correct answer: B — Post-transplant lymphoproliferative disorder

EBV-positive polymorphic B-cell proliferation with elevated EBV viral load in a transplant recipient is PTLD. It is the second most common malignancy post-transplant (after skin cancer). Risk factors: EBV-seronegative recipient, anti-thymocyte globulin, high immunosuppression burden. First-line treatment: reduction of immunosuppression (may achieve complete remission in 30-50%). Second-line: rituximab (CD20+) ± chemotherapy.

Reference: TSANZ – 2024 – PTLD; ESOT 2024