Figure 1059

Epstein-Barr virus (EBV). EBV is associated with asymptomatic infection, mononucleosis, hepatitis, and, rarely, interstitial nephritis. In transplant recipients, posttransplant lympho-proliferative disorder (PTLD) is also associated with EBV. EBV promotes B-cell proliferation, if left unchecked by immunosuppressive agents targeting the T-cell system. This chest radiograph shows multiple pulmonary nodules of PTLD. Symptoms vary from no symptoms to diffuse organ involvement causing dysfunction. Any area of the body may be involved, with frequent sites being the gums, chest, abdomen, and central nervous system.

PTLD occurs during the first posttransplant year in approximately 50% of those developing PTLD. It is seen in 1% to 2% of renal transplant recipients. Primary EBV infection following transplantation and antilymphocyte agent use is associated with an increased risk. Increasing quantitative blood EBV DNA levels may predict the onset of PTLD.

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