{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T07:02:18Z","timestamp":1780556538650,"version":"3.54.1"},"reference-count":21,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Post-transplant lymphoproliferative disorder (PTLD) involving the central nervous system (CNS) is a rare but serious life-threatening complication seen in recipients of solid organ transplant. Primary CNS encompasses 5\u201315% of all types of PTLD diagnoses, and heart transplant recipients represent 3\u20135% of those reported cases. Diagnosis is often delayed due to the highly variable presentation, with some cases remaining undiagnosed for years. Multidisciplinary collaboration is crucial for early diagnosis and management. A 53-year-old woman patient presented with altered mental status. MRI revealed nodular ventriculitis and bilateral periventricular hyperdense infiltrates. CSF studies demonstrated lymphocytic pleocytosis, elevated protein, and EBV-PCR-positive results. A stereotactic brain needle biopsy confirmed the presence of EBV-positive diffuse large B-cell lymphoma, consistent with primary CNS PTLD, 14 months after her heart transplant. Despite appropriate management, the patient experienced progressive neurological decline and ultimately suffered a fatal intracerebral hemorrhage. We demonstrate the importance of the early diagnosis and variable presentation of post-heart-transplant PTLD. The importance of surveillance regardless of EBV status and close monitoring of disease progression due to potential life-threatening complications, such as fatal hemorrhages. Therefore, primary CNS-PTLD remains a challenging disease and is being increasingly recognized with improved transplant recipient survival and prolonged exposure to chronic immunosuppression.<\/jats:p>","DOI":"10.3390\/curroncol33060333","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T06:04:12Z","timestamp":1780553052000},"page":"333","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Time Is Key: Early Diagnosis of Post-Transplant Lymphoproliferative Disorder Presenting as Primary CNS Diffuse Large B-Cell Lymphoma"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6498-8385","authenticated-orcid":false,"given":"Asli","family":"Altunbas","sequence":"first","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2502-6153","authenticated-orcid":false,"given":"Aarti","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Muniz","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5681-0600","authenticated-orcid":false,"given":"Hussien","family":"Al Asi","sequence":"additional","affiliation":[{"name":"Computational Pathology and AI, Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajvi","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4404-0559","authenticated-orcid":false,"given":"Laxmi Raj","family":"Bangari","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surbhi","family":"Dadwal","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7820-3842","authenticated-orcid":false,"given":"Juan","family":"Leoni","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Hammack","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5308-1575","authenticated-orcid":false,"given":"Harry","family":"Powers","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Foran","sequence":"additional","affiliation":[{"name":"Division of Hematology, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0921-1416","authenticated-orcid":false,"given":"Rohan","family":"Goswami","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"132455","DOI":"10.1016\/j.ijcard.2024.132455","article-title":"Incidence of de novo malignancy and all-cause mortality among heart transplant recipients","volume":"415","author":"Barrera","year":"2024","journal-title":"Int. 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