{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T06:05:05Z","timestamp":1781071505690,"version":"3.54.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Uniwersytet Medyczny im. Piast\u00f3w Slaskich we Wroclawiu","doi-asserted-by":"publisher","award":["SUBZ.C200.25.080"],"award-info":[{"award-number":["SUBZ.C200.25.080"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Epstein\u2013Barr virus (EBV) is a common trigger of secondary hemophagocytic lymphohistiocytosis (HLH), particularly in transplant recipients. Adoptive cellular therapy with EBV-specific T cells is an emerging option for refractory EBV-driven disease but may precipitate cytokine toxicities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case<\/jats:title>\n                    <jats:p>We report a boy with a history of congenital nephrotic syndrome who in infancy underwent maternal kidney transplantation. At the age of 6 years, he developed monomorphic EBV-positive post-transplant lymphoproliferative disorder, followed by EBV-driven HLH. Despite etoposide- and steroid-based HLH therapy, IVIG, anakinra, and a maternal virus-specific T-cell infusion, he showed recurrent hyperinflammation. After a single dose of the allogeneic EBV-specific T-cell product tabelecleucel (Ebvallo) and exacerbation of HLH, he experienced cytokine release syndrome and neurotoxicity with acute liver failure, coagulopathy, and renal failure. He died from refractory lactic acidosis and multiorgan failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the therapeutic complexity of EBV-HLH in a solid-organ transplant recipient and underscores both the rationale for and risks of cellular immunotherapy amid severe hyperinflammation and organ dysfunction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1840732","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:41:40Z","timestamp":1781070100000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Hyperinflammatory toxicities after Epstein\u2013Barr virus-associated post-transplant lymphoproliferative disorder and hemophagocytic lymphohistiocytosis in a pediatric kidney transplant recipient"],"prefix":"10.3389","volume":"17","author":[{"given":"Marek","family":"Ussowicz","sequence":"first","affiliation":[{"name":"Department of Paediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University","place":["Wroc\u0142aw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wioletta","family":"Jarmu\u017cek","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kidney Transplantation, and Hypertension, The Children\u2019s Memorial Health Institute","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Rutynowska-Pronicka","sequence":"additional","affiliation":[{"name":"Department of Oncology, The Children\u2019s Memorial Health Institute","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"\u015aliwi\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, The Children\u2019s Memorial Health Institute","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Bogacz","sequence":"additional","affiliation":[{"name":"Department of Cancer Immunology, Poznan University of Medical Sciences","place":["Poznan, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzena","family":"Zieli\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Wroclaw Medical University","place":["Wroc\u0142aw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mieczys\u0142aw","family":"Litwin","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kidney Transplantation, and Hypertension, The Children\u2019s Memorial Health Institute","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo\u017cenna","family":"Dembowska-Bagi\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Oncology, The Children\u2019s Memorial Health Institute","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2023-224123","article-title":"The 2022 EULAR\/ACR points to consider at the early stages of diagnosis and management of suspected haemophagocytic lymphohistiocytosis\/macrophage activation syndrome (HLH\/MAS)","volume":"82","author":"Shakoory","year":"2023","journal-title":"Ann Rheum Dis"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-023-02155-5","article-title":"Rituximab for posttransplant lymphoproliferative disorder \u2013 therapeutic, preemptive, or 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