Recurrent Bleeding Of A Duodenal Ulcer In A 55-Year-Old Man After Heart Transplantation

Duodenal ulcers are most often caused by Helicobacter pylori (HP) infection, followed by nonsteroidal anti-inflammatory drugs and hypoperfusion. Posttransplant lymphoproliferative disorder (PTLD) occurs in about 1-6.3% of patients with aheart transplant under immunosuppression therapy. Up to 25% of cases of PTLD have gastrointestinal involvement. Due to awide spectrum of clinical symptoms and pathological entities, the diagnosis can be challenging. We report the case of a55-year-old man 12years after receiving aheart transplant being treated with immunosuppressive agents (tacrolimus) who presented with recurrent bleeding from peptic duodeni. Immunohistochemistry revealed arare Epstein-Barr-virus-associated polymorphic PTLD. Rarely, PTLD can manifest only with isolated lesions of the duodenal bulb. The course was progressive, going from an incidental finding requiring transfusion anemia to a perforation within 1month. Repeated endoscopic interventions were unsuccessful. After asurgical intervention the patient died in the course of multiple organ failure. Retrospectively, areduction of immunosuppression in polymorphic PTLD would have been atreatment option.