Latent intracellular Epstein-Barr Virus DNA demonstrated in ocular posttransplant lymphoproliferative disorder mimicking granulomatous uveitis with iris nodules in a child

EBV-induced polymorphic lymphoproliferative disorder of the iris after heart transplantation

“…With this conservative therapy, the slight PTLD nodule in the left eye regressed, but the iris mass in the right eye could not be controlled. Therefore, radiation therapy was applied, which resulted in complete resolution as was observed by other authors [1,2,18]. Experiences with radiation therapy of iris PTLD are limited, but 20 or 25 Gy may be sufficient.…”

“…With modern techniques, EBV is detectable within the iris tissue. If conservative treatment is unsuccessful, radiation therapy with 20-30 Gy is highly effective, at least in controlling the lymphoproliferation [1,2,18]. With ex vivo expansion of EBV-infected B-lymphocytes and generation of virusspecific T-cells there is a new immunologic therapy available that may have benefits not only for non-ocular but also for ocular PTLD in the future.…”

“…Surgical excision of the involved iris may be beneficial in certain patients [5]. Topical corticosteroids seem to have only little value [18]. The reported results of the immunologic therapy with ex vivo expansion of virus-specific T-cells are promising, but it is still an experimental procedure.…”

“…Besides keratic precipitates and anterior chamber cells, there is a uni-or bilateral, flesh-colored iris mass that may show prominent vessels [1,3,5,7,14,18] (Figs. 1, 2, 3).…”

“…Most cases of PTLD are caused by a chronic EBV infection [1,5,8,10,11,14,17,18,24]. EBV-seronegative transplant recipients are at much greater risk to develop PTLD than those patients with detectable EBV antibodies at the time of organ transplantation [3,4,24].…”