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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, PTLD | 1A0 Case 1 History
Case 1 History ---- This patient was a 7-month old former 37-week estimated gestational age male with a past medical history significant for complex congenital heart disease status post orthotopic heart transplant in November of 2009 and subsequent development of post-transplant lymphoproliferative disorder (PTLD). ---- The patient’s history included immediately post-delivery an echocardiogram was performed to further evaluate findings noted on prenatal ultrasound. Transposition of the great arteries, coarctation of the aorta, a membranous VSD, pulmonary hypertension, and other abnormalities were noted. He had multiple admissions for heart failure over the next month. In October, he was readmitted again with signs of pulmonary hypertension and heart failure. His cardiopulmonary status worsened requiring ECMO therapy. An orthotopic heart transplant was performed in November 2009. His post-transplant course was complicated by poor biventricular function and hypotension. He also developed seizures requiring anti-epileptic therapy. He developed an EBV viremia which required the initiation of ganciclovir therapy and discontinuation of his immunosuppressant drugs. He had several bacterial infections which were treated appropriately. He failed extubation several times requiring tracheostomy placement. He also had renal failure requiring peritoneal dialysis. Due to continued respiratory difficulties and EBV infection, a whole body PET was performed which noted multiple areas of increased FDG uptake consistent with PTLD. He was readmitted in February for his final admission with fever, tachypnea and tachycardia, amphophilic and agitation. Upon arrival his EBV viral load was noted to be elevated. A repeat PET noted FDG uptake in the bones, lung and liver. Biopsies of both liver and bone marrow were consistent with PTLD. He was begun on cytoxan, rituximab, and steroids and continued on this regimen until expiration. Because of the continued worsening of his clinical status (marked by encephalopathy, agitation, and uncontrolled seizures), as well as the inability to control his EBV infection, care was redirected and he died the same day.
