Epstein-Barr virus-associated lymphoproliferative disease in oral cavity in a renal transplant recipient: a case report

A 10-yr-old child on long-term cyclosporin immunosuppression for a renal transplant presented with gingival swelling enlargement, in a background of gingival hyperplasia. It is tempting to assume that it is a drug-related lesion; perhaps, an area of plaque-related inflammation. An incisional biopsy revealed a monomorphic B-cell post-transplant lymphoproliferative disease (PTLD). At this stage, high Epstein-Barrr virus (EBV) titres supported a diagnosis of EBV-driven PTLD. Despite discontinuation of cyclosporin and reduction of EBV viral load to undetectable levels, there was considerable enlargement of the tumour. The patient underwent six courses of cyclophosphamide, vincristine and prednisolone chemotherapy. This resulted in a dramatic reduction in the size of the right mandibular mass with complete mucosal healing intra-orally. Her renal transplant still has good function and there is no evidence of PTLD recurrence 23 months after initial diagnosis. This case illustrates that PTLD can manifest in unusual sites and in transplant recipients on cyclosporin immunosuppression it is easy to assume that any gingival hyperplasia is drug induced; however, the differential diagnosis of gingival hyperplasia should include PTLD.