Treatment of Epstein-Barr virus-induced posttransplantation lymphoproliferative disorder with Foscarnet alone in an adult after simultaneous heart and renal transplantation

Background. The kind and intensity or immunosuppression as well as Epstein- Barr virus, a transforming herpes virus that selectively infects B lymphocy tes and causes infectious mononucleosis, have been implicated in the develo pment of posttransplantation lymph-proliferative disorders (PT-LPD), a life -threatening complication of solid organ transplantation. The morphologic s pectrum of PT-LPD ranges from polymorphous hyperplasia to monomorphous B-no n-Hodgkin lymphomas, Among different modalities of treatment, reduction of immunosuppression with or without coadministration of antiviral agents may result in PT-LPD regression especially in mononucleosis-like disease. Methods. Nonmononucleosis-like PT-LPD in a simultaneous heart and renal rec ipient was treated with Foscarnet, a potent inhibitor of different herpes v iruses with a low profile of toxicity, although intensive immunosuppression therapy was maintained. Results and conclusions. A 4-week course of Foscarnet resulted in relapse-f ree complete remission (follow-up 10+ months). Thus, antiviral treatment wi th Foscarnet, may induce prolonged remission in nonmononucleosis-like PT-LP D without reduction of immunosuppression.