An Unusual Presentation of Post-transplant Lymphoproliferative Disorder Mimicking Vasculitis in Heart Transplantation

This report details an unusual case of Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorder (PTLD) involving the epicardial coronary arteries and myocardial arterioles of an allograft heart, morphologically mimicking vasculitis, a finding associated with acute rejection, cardiac allograft vasculopathy (CAV), infection and infarction. Recognition of this novel PTLD pattern as a potential imitator of acute rejection in particular is important because reduction of immunosuppression (to treat PTLD) is antithetical to the usual therapy for rejection.