Coexistence of acute cellular rejection and lymphoproliferative disorder in a lung transplant patient

We report the case of a 37-year-old man who underwent bilateral lung transp lantation for end-stage cystic fibrosis. Two months after his operation, a computed tomographic scan showed multifocal nodules throughout both lungs. Endobronchial biopsies revealed an Epstein-Barr virus-associated B-cell lym phoproliferation. Transbronchial biopsies revealed perivascular lymphoid in filtrates composed of predominantly small T lymphocytes. These perivascular infiltrates were retrospectively considered to be an acute cellular reject ion rather than the periphery of the lymphoproliferative disorder. This opi nion was based on several arguments: (a) a decrease in dosage of maintenanc e immunosuppression led to total regression of the lymphoproliferation but did not affect the perivascular lymphoid infiltrates; (b) the treatment of the acute cellular rejection temporarily induced the disappearance of the p erivascular infiltrates; (c) the expression of Epstein-Barr virus was not d etected in the perivascular infiltrates; and (d) on autopsy, performed 1 ye ar later, severe obliterative bronchiolitis lesions were discovered, for wh ich acute cellular rejection is the main risk factor. These observations po int to the possibility that acute cellular rejection and an Epstein-Barr vi rus-associated lymphoproliferative disorder may coexist.