Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 37(2): 133-140 (2021)

症例報告Case Report

末梢血のEBウイルス感染細胞同定解析に基づき早期に治療開始できた心臓移植後リンパ増殖性疾患の1例Identification of Peripheral Blood Cells Infected with Epstein–Barr Virus: A Practical Method for Choosing the Initial Treatment for Post-Transplantation Lymphoproliferative Disease

1東京大学医学部附属病院小児科Department of Pediatrics, The University of Tokyo Hospital ◇ Tokyo, Japan

2国立研究開発法人国立成育医療研究センター 高度感染症診断部Division of Advanced Medicine for Virus Infections, National Center for Child Health and Development ◇ Tokyo, Japan

3東京大学医学部附属病院病理部Department of Pathology, The University of Tokyo Hospital ◇ Tokyo, Japan

受付日:2020年9月23日Received: September 23, 2020
受理日:2020年12月21日Accepted: December 21, 2020
発行日:2021年8月1日Published: August 1, 2021

移植後リンパ増殖性疾患(post transplantation lymphoproliferative disease: PTLD)の治療において,リツキシマブの適応は一般的に臨床像および生検結果に基づいて決定する.今回,末梢血のEpstein–Barr(EB)ウイルス感染細胞同定解析に基づき,生検結果が判明するよりも早くリツキシマブの適応があるかを調べられたPTLDの症例を経験した.本症例は2歳男児で,心臓移植の3か月後に発熱・気道症状・下痢症状でPTLDを発症し入院した.入院中に行った末梢血のEBウイルス感染細胞同定解析により,感染細胞がB細胞由来で,リツキシマブの適応があることがわかった.これに基づき,生検結果が判明するより先にリツキシマブを投与開始できた.末梢血のEBウイルス感染細胞同定解析は,生検結果が判明するまで待てないPTLD症例において,リツキシマブの適応があるかを早期に把握する有効な手立てとなる可能性がある.

Using rituximab for treating post-transplantation lymphoproliferative disease (PTLD) is generally decided according to the clinical presentation and pathology. We report a PTLD case treated with rituximab on the basis of the detected peripheral blood cells infected with Epstein–Barr virus. A 2-year-old boy diagnosed with PTLD 3 months after heart transplantation manifested fever, respiratory symptoms, and diarrhea. Identification of peripheral blood cells infected with the virus showed that such cells were of B cell origin, indicating that the patient may benefit from rituximab treatment. This result enabled us to use rituximab before the biopsy results came out. Therefore, identification of peripheral blood cells infected with Epstein–Barr virus may help quickly decide whether to use rituximab in patients with PTLD whose biopsy results may be delayed.

Key words: post-transplantation lymphoproliferative disease; heart transplant; Epstein–Barr virus; flowcytometry

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