Pediatr Allergy Respir Dis.  2004 Sep;14(3):239-244.

Lymphoproliferative Disorder as an Unusual Causen of Stridor in a Post-Liver Transplant Child

Affiliations
  • 1Department of Pediatrics, Soonchunhyang University Hospital, Bucheon, Korea.
  • 2Department of Pediatrics, Dong-A University Hospital, Busan, Korea.
  • 3Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. kmaped@smc.samsung.co.kr
  • 4Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 5Department of Otolaryngology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 6Department of Pediatric Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Otolaryngologic symptoms and findings are often the first manifestations of post-transplant lymphoproliferative disorder (PTLD) in children. We report a case of lymphoproliferative disorder which occurring in the epiglottis and aryepiglottic fold of a post-liver transplant, 28-month-old girl. Inspiratory stridor and mild respiratory distress were presented 7 months after the transplantation. Bronchoscopy revealed swelling of the epiglottis, multiple nodular lesions in the arytenoid and the pharyngeal wall, and collapse of the false vocal cord due to a redundant nodular mass during inspiration. Microscopic examination showed polymorphic, polyclonal small lymphoid aggregates, which were dominantly stained by monoclonal antibody to CD20. In this case, PTLD was associated with Epstein-Barr virus (EBV) infection. The patient was treated successfully by the surgical excision of the obstructing redundant mass in the arytenoids, dose reduction of immunosuppressive drugs and the administration of an antiviral agent. A diagnosis of PTLD should be considered in transplanted children who later develop upper airway obstruction.

Keyword

Lymphoproliferative disorder; Epstein-Barr virus; Stridor; Liver transplantation

MeSH Terms

Airway Obstruction
Bronchoscopy
Child*
Child, Preschool
Diagnosis
Epiglottis
Female
Herpesvirus 4, Human
Humans
Liver Transplantation
Lymphoproliferative Disorders*
Respiratory Sounds*
Vocal Cords
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