After kidney transplantation, a patient on triple immunosuppression (tacrolimus, mycophenolate mofetil, prednisolone) develops a cervical lymphadenopathy at 14 months. Biopsy shows an EBV-associated B-cell lymphoproliferative disorder. This condition is classified as:
- A Post-transplant lymphoproliferative disease (PTLD), and first-line management includes reduction of immunosuppression ✓
- B De novo diffuse large B-cell lymphoma unrelated to immunosuppression
- C Graft-versus-host disease involving lymph nodes
- D CMV lymphadenitis requiring ganciclovir
Correct answer: A. Post-transplant lymphoproliferative disease (PTLD), and first-line management includes reduction of immunosuppression
Explanation
Post-transplant lymphoproliferative disease (PTLD) is a spectrum of EBV-driven B-cell proliferation occurring in immunosuppressed transplant recipients, with an incidence of 1–5%. First-line management is reduction or withdrawal of immunosuppression, which allows EBV-specific T-cell surveillance to recover and may induce regression. Rituximab (anti-CD20) is added for CD20-positive lesions unresponsive to IS reduction. Chemotherapy (CHOP) is used for resistant or aggressive histological types. CMV lymphadenitis is CD8+ T-cell driven, not B-cell lymphoproliferative.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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