Course 19, Case 9
Revised 2010
Kas 19-9E: Night sweating, weight loss, lymphadenopathy – posttransplant
lymphopropliferation
Present history
20 years old patient, 4 years after heart transplantation (dilated cardiomyopathy) was admitted
for weight loss, fever and night sweating. The patient has not felt well the last three weeks,
and he has had body temperature 37.7 in the afternoon without chill and shivering. He lost his
apetit and had weightloss. He has palpated inguinal and cervical lymphadenopathy.
Family history: nonremasrkable
Past history: Heart transplantation in age of 16 years for dilated cardiomyopathy
Posttransplant period – recurrent upper airway infections
Pharmacology history.
Immunosupression: Cyclosporin A, Mycofenolat mofetyl, Prednison.
Examination:
Cervical and inguinal lymphadenopathy, otherwise normal
Laboratory findings:
CRP 60, high LDH (6,2) otherwise normal
Chest X-ray: normal
ECG: sinus tachycardia, otherwise normal curve.
Questions:
1. What are immunology risks in transplantation, what is the solution?
2. The patient underwent allogenic transplantation of heart. What other types of
transplantation according to immunogenetic concordance do you know?
3. What type of disease could cause these symptoms and findings, what is the
immunopathologic mechanism of the disease?
4. Explain the immunologic principle of the following phenomenon: HVGD, GVHD,
5. PP: Explain hemodynamic changes in patients with dilated cardiomyopathy
6. Pa: Acute and chronic graft rejection