Medical Case Study Sample

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Case 679 ________________________________________ CLINICAL HISTORY The patient is a 10 year old female, who underwent liver transplantation at the age of 2 for Alagille syndrome-related end-stage liver disease. Prior to transplantation, she received 36 mg of thymoglobulin followed by 24 mg post transplant, and tacrolimus 2 mg twice daily. Her immediate post transplant course was complicated by a pulmonary thromboembolism and acute cellular rejection which were treated with corticosteroids and antibiotics. Approximately one year after transplant, the patient presented with flu-like symptoms that included fever, rhinorrhea, body aches and an EBV titer of 30 million copies/ml. She was admitted for ganciclovir and CytoGam administration with EBV surveillance. An abdominal CT scan demonstrated a liver lesion along with cervical and axillary adenopathy. A liver biopsy demonstrated a hepatic Epstein-Barr virus-associated smooth muscle tumor. A lymph node biopsy revealed a CD20 positive infectious mononucleosis-like post transplant lymphoproliferative disorder (PTLD). Immunosuppression was suspended, and she was treated with ganciclovir, CMV-IGIV and rituximab. Despite the reduction in immunosuppression, her liver lesions increased in size. Chemotherapy was felt to be of no additional benefit in treating the CD20 negative liver lesion. The liver lesions were monitored with scans She received 4 doses of…show more content…
Best treatments ; Immediate and aggressive chemothereapy to treat the leukemia, the patient will need another liver transplant within the next 3-5 years if chemotherapy is successful, as well as being enrolled in the George Hubert study group, the patient displays a myeloid/erythrocyte count above the 5.o mark, making her a rare candidate for the

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