Primary central nervous system post-transplant lymphoproliferative disorders: the spectrum of imaging appearances and differential

White, Matthew L.; Moore, Drew W.; Zhang, Yan; Mark, Keiper D.; Greiner, Timothy C.; Bierman, Philip J.

doi:10.1186/s13244-019-0726-6

Cited by 30 publications

(66 citation statements)

References 51 publications

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“…Due to the immunosuppressed status of the patients and the non-specific MRI findings, a thorough evaluation of vascular, infectious, and other neoplastic etiologies such as cerebral abscess, posterior reversable encephalopathy syndrome (PRES), stroke, cerebral venous sinus thrombosis, demyelination, infectious encephalitis, autoimmune encephalitis, glioblastoma, and metastatic disease must be undertaken by treating physicians [ 11 ]. A summary of relevant testing is highlighted in Table 2 .…”

Section: Discussionmentioning

confidence: 99%

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The spectrum of Epstein-Barr virus infections of the central nervous system after organ transplantation

Ridha

Jones

Lerner

et al. 2021

Virol J

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Background Epstein-Barr virus (EBV)-related neurologic complications have a diverse presentation in transplant recipients, creating diagnostic and therapeutic challenges for clinicians. In this case series, we report unique manifestations of EBV related neurologic complications following solid organ transplant and highlight pitfalls in management. Case presentations A retrospective search of the electronic medical record of all patients from January 2015 to December 2020 who underwent solid organ transplantation and had central nervous system complications as determined by ICD-10 codes were included. Three patients with unique manifestation of EBV-related neurologic complications after liver transplantation were identified. The first was a 52-year-old man with a live-donor liver transplant 11 years prior for Budd-Chiari syndrome presented with several weeks of headache and several lesions on brain MRI; he was diagnosed with primary central nervous system post-transplant lymphoproliferative disorder. The second patient was a 63-year-old man with a deceased-donor liver transplant 16 years prior for alpha-1-antitrypsin deficiency and was found to have a stroke; he was diagnosed with EBV encephalitis. The final patient was a 75-year-old woman with a deceased-donor liver transplant six years prior for primary biliary cirrhosis who presented with four months of gait instability; she was diagnosed with EBV myelitis. A review of the literature was performed to supplement description of the different diseases. Conclusions EBV-related central nervous infection in post-transplant patients can manifest in a variety of neurologic syndromes, which can be challenging to diagnose. Careful correlation of clinical, pathologic, and radiologic findings and a high index of suspicion are crucial in identification and appropriate management.

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Section: Discussionmentioning

confidence: 99%

“…Radiographically, lesions are commonly multifocal with preferential involvement of periventricular structures with or without meningeal enhancement or hemorrhage. Lesions are typically contrast enhancing with variable patterns (homogenous, ring, or heterogeneous) [ 5 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

The spectrum of Epstein-Barr virus infections of the central nervous system after organ transplantation

Ridha

Jones

Lerner

et al. 2021

Virol J

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Section: Investigation Modalitiesmentioning

confidence: 99%

The Spectrum of Epstein-Barr Virus Infections of the Central Nervous System After Organ Transplantation

Ridha

Jones

Lerner

et al. 2021

Preprint

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BackgroundEpstein-Barr virus (EBV)-related neurologic complications have a diverse presentation in transplant recipients, creating diagnostic and therapeutic challenges for clinicians. In this case series, we report unique manifestations of EBV related neurologic complications following solid organ transplant and highlight pitfalls in management. Case Presentations:A retrospective search of the electronic medical record of all patients from January 2015 and December 2020 who underwent solid organ transplantation and had central nervous system complications as determined by ICD-10 codes were included. Three patients with unique manifestation of EBV-related neurologic complications after liver transplantation were identified. The first was a 52-year-old man with a live-donor liver transplant 11 years prior for Budd-Chiari syndrome presented with several weeks of headache and found to have several lesion on brain MRI who was diagnosed with primary central nervous system post-transplant lymphoproliferative disorder. The second patient was a 63-year-old man with a deceased-donor liver transplant 16 years prior for alpha-1-antitrypsin deficiency who was found to have a stroke and was diagnosed with EBV encephalitis with vasculitis. The final patient was a 75-year-old woman with a deceased-donor liver transplant six years prior for primary biliary cirrhosis who presented with four months of gait instability and was diagnosed with EBV myelitis. A review of the literature was performed to supplement description of the different diseases. ConclusionsEBV-related central nervous infection in post-transplant patients can manifest in a variety of neurologic syndromes, which can be challenging to diagnose. Careful correlation of clinical, pathologic, and radiologic findings and a high index of suspicion are crucial in identification and appropriate management.

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“…CNS-PTLD lesions tend to be multifocal, ringenhancing, or homogenously enhancing lesions with mass effect and with associated restricted diffusion. 84…”

Section: Primary Cns Posttransplantation Lymphoproliferative Disordersmentioning

confidence: 99%

Approach to Neurologic Complications in the Immunocompromised Patient

Vishnevetsky

Anand

2021

Semin Neurol

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Neurologic complications are common in immunocompromised patients, including those with advanced human immunodeficiency virus, transplant recipients, and patients on immunomodulatory medications. In addition to the standard differential diagnosis, specific pathogens and other conditions unique to the immunocompromised state should be considered in the evaluation of neurologic complaints in this patient population. A thorough understanding of these considerations is critical to the inpatient neurologist in contemporary practice, as increasing numbers of patients are exposed to immunomodulatory therapies. In this review, we provide a chief complaint-based approach to the clinical presentations and diagnosis of both infectious and noninfectious complications particular to immunocompromised patients.

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Primary central nervous system post-transplant lymphoproliferative disorders: the spectrum of imaging appearances and differential

Cited by 30 publications

References 51 publications

The spectrum of Epstein-Barr virus infections of the central nervous system after organ transplantation

The spectrum of Epstein-Barr virus infections of the central nervous system after organ transplantation

The Spectrum of Epstein-Barr Virus Infections of the Central Nervous System After Organ Transplantation

Approach to Neurologic Complications in the Immunocompromised Patient

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