Posttransplant lymphoproliferative disorder (PTLD) is now a well-documented and serious complication of organ transplantation, ranging from polyclonal lymphoid hyperplasia to malignant lymphoma. PTLD is due to the combined effects of lymphoid proliferation induced by Epstein-Barr virus (EBV) infection, and the disruption of normal immume control by cytotoxic T cells. It is also strongly related to the potency and the cumulative doses of immunosuppressants and the type of organ transplantation. We report four cases of PTLD after renal transplantation, for whom three cases were EBV-positive by in situ hybridization.

Varicella is usually a benign childhood disease, while in the adult is an infrequent but potentially serious infection. Varicella pneumonia is a potentially life-threatening complication that should be suspected in any adult with chickenpox and respiratory symptoms. In the adult it may be complicated by pneumonia with high morbidity and mortality rates. We present a case of varicella pneumonia complicated the course of chickenpox in the living-related donor renal transplant recipient. A 30-year-old male received an allograft kidney from his father following treatment with cyclosporine and low-dose steroids. Allograft function was stable over the next 27 months. He was admitted hospital with a week history of generalized varicelliform rash, malaise, fever, chills and a cough. Three weeks ago, his nephew (7-year-old) had chickenpox who was living together in the same house. On examination he looked severely ill, febrile and his skin was covered with typical chickenpox eruption. Auscultatory examination was unremarkable while chest X-rays revealed bilateral interstitial infiltration. HRCT findings showed multiple variable sized nodules, patchy ground-glass opacities, and some consolidation in both lower lung. Treament with i.v. acyclovir was started and continued for 10 days. The patient response to the treatment was excellent with complete resolution of pneumonia.