RAPIDLY GROWING EPSTEIN-BARR VIRUS-ASSOCIATED PULMONARY LYMPHOMA AFTER HEART-TRANSPLANTATION

There is strong evidence to show an association of Epstein-Barr virus (EBV) infection with the development of post-transplant lymphoprolifer ative disease. We report the rapid development of a malignant lymphoma in a heart transplant recipient, which occurred within less than eigh t weeks. The diagnosis of this malignant high grade B-cell lymphoma wa s established by open lung biopsy, and classified as centroblastic lym phoma of polymorphic subtype. Immunohistochemically, the lymphoma show ed reactivity with the B-cell markers L-26 (CD20) and Ki-B5 and with t he activation marker Ber-H2 (CD30). Furthermore, an expression of the bcl-2 oncoprotein was detected. Monoclonal IH gene rearrangement was d emonstrated by polymerase chain reaction (PCR), indicating monoclonal proliferation of B-blasts. Although serum EBV immunoglobulin M (IgM) a ntibodies were negative, the association to an EBV infection could be demonstrated by EBV immunostaining pattern which revealed an expressio n of the latent membrane protein (LMP) of EBV in the atypical blasts. The results give clear evidence of an EBV association of this rapidly growing lymphoma developed after heart transplantation.