Case 10 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 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. 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. A whole body PET was performed which noted multiple areas of increased FDG uptake consistent with PTLD which was confirmed by liver and done marrow biopsy. 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.
