PTLD can be a consequence of T-cell suppression with long-term cyclosporine use. The overall incidence in lung transplant patients is approximately 8 percent. The disease tends to occur with primary EBV infection following lung transplant. Because younger patients are more likely to be EBV-negative at the time of transplantation, they tend to develop EBV infection and PTLD at a higher rate. Presenting features include isolated lymphadenopathy, painful otitis media (secondary to tonsillar involvement), or a viral-like syndrome. PTLD within 1 year of transplantation is usually localized and can be successfully treated with reduced immunosuppression and high-dose acyclovir, with a relatively good prognosis. In contrast, PTLD after 1 year tends to be disseminated, unresponsive to treatment, and usually fatal.
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