Post-Transplant Lymphoproliferative Disorder Presenting as Biventricular Failure After Heart Transplantation.

Background: The diagnosis of post-transplant lymphoproliferative disorder (PTLD) is challenging because of its diverse clinical presentations.

Case Summary: A 65-year-old man, previously stable 61 months after heart transplantation for dilated cardiomyopathy, presented with biventricular failure and worsening dyspnea. Given the acute decline in graft function, acute rejection was suspected, and rejection therapy was initiated. However, the patient showed no clinical improvement, and he required venoarterial extracorporeal membrane oxygenation support as a bridge to redo heart transplantation. Pathologic evaluation of the explanted heart revealed a diagnosis of PTLD.

Discussion: This case underscores importance of recognizing PTLD as a potential cause of graft dysfunction in heart transplant recipients, particularly when rejection therapy is ineffective and biopsy findings are atypical. Further research is necessary to establish optimal treatment approaches.

Take-home Messages: PTLD can mimic acute rejection in heart transplant recipients, thus necessitating thorough histopathologic evaluation. Effective management, including tailored immunosuppressive strategy following retransplantation, needs further investigation.