Discrepancy in EBV-DNA load between peripheral blood and cerebrospinal fluid in a patient with isolated CNS post-transplant lymphoproliferative disorder

Int J Hematol. 2011 Nov;94(5):495-8. doi: 10.1007/s12185-011-0951-3. Epub 2011 Oct 29.


Post-transplant lymphoproliferative disorder (PTLD) is a fatal complication of allogeneic hematopoietic stem cell transplantation (HSCT) that is caused by reactivation of Epstein-Barr virus (EBV). A successful approach, monitoring EBV-DNA load in peripheral blood (PB) accompanied by preemptive rituximab therapy, has recently been reported. Here, we describe a 29-year-old woman who developed isolated central nervous system (CNS) PTLD. She received HSCT against acute myelogenous leukemia from a related human leukocyte antigen-haploidentical donor, following a conditioning regimen that included antithymocyte globulin. Tacrolimus and methylprednisolone were given as prophylaxis for graft-versus-host disease. On day +172, the patient's consciousness deteriorated. Magnetic resonance imaging showed six ring-enhanced lesions in the cerebral hemispheres. These tumors were diagnosed, via a craniotomy and tumorectomy, as PTLD. EBV-DNA load was elevated in the cerebrospinal fluid (CSF) but not detected in PB. She was treated with whole-brain irradiation and rituximab, and achieved partial remission of the tumors. This case serves as a reminder that vigilance is required regarding the development of isolated CNS PTLD; it is worth examining EBV-DNA replication in CSF for diagnosis even when the EBV-DNA load is negative in PB.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Brain Diseases / therapy
  • Brain Diseases / virology*
  • DNA, Viral / blood
  • DNA, Viral / cerebrospinal fluid*
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Herpesvirus 4, Human / genetics*
  • Herpesvirus 4, Human / physiology
  • Humans
  • Leukemia, Myeloid, Acute / therapy
  • Lymphoproliferative Disorders / therapy
  • Lymphoproliferative Disorders / virology*
  • Radiotherapy / methods
  • Rituximab
  • Transplantation, Homologous
  • Viral Load*
  • Virus Replication


  • Antibodies, Monoclonal, Murine-Derived
  • DNA, Viral
  • Rituximab