Posttransplantation lymphoproliferative disease in children: otolaryngologic manifestations and management

BACKGROUND: Posttransplantation lymphoproliferative disease (PTLD) is associated with Epstein-Barr virus (EBV) infection after solid organ and bone marrow transplantation. METHODS: We did a retrospective analysis of cases with a diagnosis of PTLD at Children's Hospital of Wisconsin. RESULTS: Ten patients were identified. Seven of 10 cases (70%) were associated with bone marrow transplantation and 3 with solid organ transplantation. Three patients (30%) died of PTLD. The average time to development of PTLD after transplantation was 120 days. CONCLUSIONS: Otolaryngologic symptoms and findings are often the first manifestations of PTLD. Associated findings in this series included tonsillar necrosis, tonsillitis, airway obstruction, lymphadenitis, sinusitis, and otitis media. Diagnosis generally requires pathologic evaluation of tonsillar or adenoid tissue. Surgical intervention may also be important for relief of airway obstruction when present. Prompt recognition, diagnosis, and intervention with reduction in immunosuppression and antiviral therapy are essential to reduce the mortality of PTLD.