Epstein-Barr virus associated CNS lymphoproliferative disorder after long-term immunosuppression

Pract Neurol. 2020 Feb;20(1):83-86. doi: 10.1136/practneurol-2019-002356. Epub 2019 Aug 29.


The incidence of Epstein-Barr virus (EBV)associated lymphoproliferative disorders has increased with greater use of immunomodulatory therapies. We present a woman who developed subacute cognitive decline and unilateral weakness while taking long-term mycophenolate mofetil for granulomatosis with polyangiitis; her postmortem brain histopathology confirmed an EBV-driven lymphoproliferative disorder. Clinicians must have a high index of suspicion for EBV-driven lymphoma in people taking long-term immunosuppression who develop new neurological problems. We review the role of mycophenolate mofetil in EBV-driven lymphoproliferative disorders, and discuss checking EBV status in all patients starting immunosuppression and in older people already taking immunosuppression.

Keywords: Epstein-Barr Virus; Lymphoproliferative Disorder; Mycophenolate Mofetil.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Cerebral Hemorrhage / diagnostic imaging*
  • Cerebral Hemorrhage / etiology
  • Cognitive Dysfunction / chemically induced
  • Cognitive Dysfunction / diagnostic imaging
  • Cognitive Dysfunction / etiology
  • Epstein-Barr Virus Infections / chemically induced
  • Epstein-Barr Virus Infections / complications
  • Epstein-Barr Virus Infections / diagnostic imaging*
  • Female
  • Humans
  • Immunosuppression Therapy / adverse effects*
  • Immunosuppression Therapy / trends
  • Immunosuppressive Agents / adverse effects*
  • Lymphoproliferative Disorders / diagnostic imaging*
  • Lymphoproliferative Disorders / etiology
  • Mycophenolic Acid / adverse effects


  • Immunosuppressive Agents
  • Mycophenolic Acid