SpringerLink
Log in

Recurrent bleeding duodenal and colonic ulcers due to post-transplant lymphoproliferative disorder

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Post-transplant lymphoproliferative disorder (PTLD) is a rare complication of solid organ transplantation as the result of immunosuppressant medications. Epstein–Barr virus (EBV) has been implicated in most of these cases, specifically with B-cell predominant lymphoma. This case report describes a 24-year-old female who presented with recurrent GI bleed within 6 months post-orthostatic heart transplant. Endoscopic evaluations including video capsule study, push enteroscopy, and colonoscopy revealed multiple ulcerated lesions in duodenum, jejunum, and colon secondary to Epstein–Barr Virus-associated monomorphic PTLD. Despite continuation of rituximab after discharge, she returned to the hospital for recurrent GI bleed requiring additional endoscopic intervention. PTLD is a devastating disease of the post-transplant population. Due to a high risk of recurrent GI bleeding, patients with PTLD may benefit from careful monitoring by gastroenterology as an outpatient with a low threshold for repeat endoscopic evaluation despite being on immunotherapy or chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Al-Mansour Z, Nelson BP, Evens AM. Post-transplant lymphoproliferative disease (PTLD): risk factors, diagnosis, and current treatment strategies. Curr Hematol Malig Rep. 2013;8:173–83.

    Article  Google Scholar 

  2. Green M, Michaels MG. Epstein-Barr virus infection and posttransplant lymphoproliferative disorder. Am J Transplant. 2013;13(Suppl 3):41–54 (quiz).

    Article  CAS  Google Scholar 

  3. Patek B, Strahotin C. Early onset post-transplant lymphoproliferative disorder presenting with diarrhea post-orthotopic liver transplant treated successfully with single rituximab agent. Cureus. 2019;11: e6200.

    Google Scholar 

  4. Inayat F, Hassan GU, Tayyab GUN, et al. Post-transplantation lymphoproliferative disorder with gastrointestinal involvement. Ann Gastroenterol. 2018;31:248–51.

    Google Scholar 

  5. Younes BS, Ament ME, McDiarmid SV, et al. The involvement of the gastrointestinal tract in posttransplant lymphoproliferative disease in pediatric liver transplantation. J Pediatr Gastroenterol Nutr. 1999;28:380–5.

    Article  CAS  Google Scholar 

  6. Mukhtar MS, Wolman SL. Post-transplant lymphoproliferative disorder as a cause of oesophageal ulceration and stricture: case report and literature review. BMJ Open Gastroenterol. 2021;8:e000602.

    Article  Google Scholar 

  7. Brahmbhatt AN, Baah NYO. Embolization for acute gastrointestinal hemorrhage secondary to post-transplant lymphoproliferative disorder. Radiol Case Rep. 2020;15:396–9.

    Article  Google Scholar 

  8. Siegel A, Boike J, Trivedi I, et al. Posttransplant lymphoproliferative disorder of the small bowel as an unexpected cause of iron deficiency anemia decades after heart transplantation. ACG Case Rep J. 2017;4: e86.

    Article  Google Scholar 

  9. Gandhi S, Behling E, Behrens D, et al. Late-onset posttransplant lymphoproliferative disorders after solid organ transplantation in adults: a case series and review of the literature. Case Rep Transplant. 2020;2020:8247308.

    CAS  Google Scholar 

  10. Chia SC, Chau YP, Tan YM. Late-onset post-transplant lymphoproliferative disease presenting as massive occult gastrointestinal haemorrhage. Singap Med J. 2008;49:e117–20.

    CAS  Google Scholar 

  11. San-Juan R, Comoli P, Caillard S, et al. Epstein-Barr virus-related post-transplant lymphoproliferative disorder in solid organ transplant recipients. Clin Microbiol Infect. 2014;20(Suppl 7):109–18.

    Article  Google Scholar 

  12. Walti LN, Mugglin C, Sidler D, et al. Association of antiviral prophylaxis and rituximab use with posttransplant lymphoproliferative disorders (PTLDs): a nationwide cohort study. Am J Transplant. 2021;21:2532–42.

    Article  CAS  Google Scholar 

  13. Van Besien K, Bachier-Rodriguez L, Satlin M, et al. Prophylactic rituximab prevents EBV PTLD in haplo-cord transplant recipients at high risk. Leuk Lymphoma. 2019;60:1693–6.

    Article  Google Scholar 

  14. Shahid S, Prockop SE. Epstein-Barr virus-associated post-transplant lymphoproliferative disorders: beyond chemotherapy treatment. Cancer Drug Resist. 2021;4:646–64.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Thomas Jefferson University Hospital, 833 Chestnut St Suite 220, Philadelphia, PA, 19107, USA

    Shuji Mitsuhashi

  2. Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Divya Chalikonda, Amit Agarwal & Robert Coben

  3. Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Bushra Nazir

Authors
  1. Shuji Mitsuhashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Divya Chalikonda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bushra Nazir
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amit Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert Coben
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shuji Mitsuhashi.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mitsuhashi, S., Chalikonda, D., Nazir, B. et al. Recurrent bleeding duodenal and colonic ulcers due to post-transplant lymphoproliferative disorder. Clin J Gastroenterol 16, 39–42 (2023). https://doi.org/10.1007/s12328-022-01718-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-022-01718-1

Keywords

Search

Navigation