Don't you EXPECT to see this question in your - triplehelix

[ArchivalUser]

534.
A 59-year-old male is evaluated for worsening shortness of breath for 1 week. Fourteen months ago he
received a single right lung transplant for a history of idiopathic pulmonary fibrosis. The posttransplant
course was complicated by three episodes of acute rejection in the first year. His current
immunosuppressive medications include prednisone, tacrolimus, and mycophenolate. On physical
examination the patient is afebrile with normal vital signs except for a respiratory rate of 20/min. There
are diffuse crackles on the left and diminished breath sounds on the right with dullness to percussion. A
chest radiogram reveals a moderate to large right pleural effusion that was not present 2 months ago.
Evaluation of the pleural fluid shows malignant T lymphocytes that are consistent with primary
lymphoma. Which of the following is most likely to be responsible for the malignant pleural effusion?
A. Cytomegalovirus
B. Epstein-Barr virus
C. Human herpesvirus 8
D. Parvovirus B19
E. Respiratory syncytial virus

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[ArchivalUser]

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[ArchivalUser]

~B....

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[ArchivalUser]

B. Burkitt lymphoma.

[ArchivalUser]

B. Epstein-Barr virus

Patients who have undergone organ transplantation are at increased risk for developing PTLDs ranging from benign polyclonal hyperplasia to aggressive high-grade lymphoma (most are B-cell type). The disorders tend to occur within 1 year after transplantation (peak is 3-4 mo posttransplant). PTLDs develop in 4-10% of patients who have undergone lung transplants, as opposed to an approximate 2% incidence in other solid organ transplant recipients.

T-cell PTLDs tend to occur later and tend not to be associated with Epstein-Barr virus (EBV) infection. T-cell PTLDs are associated with a worse prognosis.

Most PTLDs are associated with concomitant EBV infections, and this may be the etiologic agent. EBV stimulates B-lymphocyte proliferation, which is unopposed because of a cyclosporin-induced inhibition of T lymphocytes. Treatment consists of decreasing or ceasing immunosuppressive therapy (ie, cyclosporin) and administering antiviral agents (ie, acyclovir). After immunomodulation, regression occurs in 23-61% of patients.

CMV is the second most common cause of pneumonia in patients who have received lung transplants,

Further Reading:
http://www.journals.uchicago.edu/doi/pdf/10.1086/516269
http://www.blackwell-synergy.com/doi/pdf...04.05212.x

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A.........

[ArchivalUser]

b.

[ArchivalUser]

B.....