Posttransplantation lymphoproliferative disease in children: Otolaryngologic manifestations and management

Background. Posttransplantation lymphoproliferative disease (PTLD) is assoc iated with Epstein-Barr virus (EBV) infection after solid organ and bone ma rrow 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 associa ted with bone marrow transplantation and 3 with solid organ transplantation . Three patients (30%) died of PTLD. The average time to development of PTL D after transplantation was 120 days. Conclusions. Otolaryngologic symptoms and findings are often the first mani festations of PTLD. Associated findings in this series included tonsillar n ecrosis, tonsillitis, airway obstruction, lymphadenitis, sinusitis, and oti tis 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 inte rvention with reduction in immunosuppression and antiviral therapy are esse ntial to reduce the mortality of PTLD.