{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T03:35:06Z","timestamp":1764732906868,"version":"3.41.2"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T00:00:00Z","timestamp":1609113600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007786","name":"National Center for Child Health and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007786","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>EBV\u2010associated HLH driven by EBV\u2010infected CD8<jats:sup>+<\/jats:sup> T cells is a rare complication after pediatric solid organ transplantation. The etiology and disease spectrum of post\u2010transplant EBV\u2010HLH are poorly understood, and making a precise diagnosis and providing optimal treatment remain a challenge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods\/Case description\/Results<\/jats:title><jats:p>We report a 2\u2010year\u2010old multivisceral transplant recipient who developed fever and cytopenia with a persistent high EBV\u2010load state. Repeated tissue examinations and CT scans could not identify a localized mass, which is the key to the diagnosis of PTLD as per the WHO classification. Hence, EBV\u2010HLH was diagnosed by clinical manifestations as well as characterization of EBV\u2010infected cells, pathological examination on cell block of pleural effusion and clonality analysis. This EBV\u2010HLH did not respond to intensive chemotherapy, resulted in the recipient's death, acting similarly to hematological malignancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Characterization of EBV\u2010infected cells in peripheral blood should be considered when persistent high EBV loads develop with symptoms consistent with PTLD, but no evidence of localized mass, and the tissue diagnosis is unavailable after pediatric solid organ transplantation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.13961","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T10:21:48Z","timestamp":1609150908000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Fatal Epstein\u2010Barr virus\u2010associated hemophagocytic lymphohistiocytosis with virus\u2010infected T cells after pediatric multivisceral transplantation: A proof\u2010of\u2010concept case report"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3393-6943","authenticated-orcid":false,"given":"Masaki","family":"Yamada","sequence":"first","affiliation":[{"name":"Department of Advanced Medicine for Viral Infections National Center for Child Health and Development (NCCHD) Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3031-7319","authenticated-orcid":false,"given":"Seisuke","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Organ Transplantation Center NCCHD Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1499-538X","authenticated-orcid":false,"given":"Kenichi","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Children\u2019s Cancer Center NCCHD Tokyo 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