Introduction: Posttransplant lymphoproliferative disease (PTLD) is a complication of organ transplantation and mainly (80%) is associated with EBV (re)infection, usually with early-onset. (1, 2) EBV-negative PTLD is mainly late-onset. The highest risk of developing PTLD is within the first year after transplantation and appears the rarest (1-3%) in kidney and liver transplants. PTLD as heart infiltration for so far was not described and the primary heart lymphoma are extremely rare (0.5-1%) so we represent this case report.

Case report: We admitted a 31-year-old male for cardiac tamponade. Seven years ago patient underwent OLT due to secondary biliary cirrhosis. Two weeks before admission he developed dull chest pain, fatigues, shortness of breath and generalized lymphadenopathy. After admission, echocardiography showed infiltrative mass of the left atrium and ventricle, the right atrium and both septa with abundant pericardial effusion. Pericardiocentesis and FNA of enlarged lymph node in the neck were done. Cytology described giant B non-Hodgkin’s lymphoma while in an effusion lymphoma cells weren’t find. Patient was empirically treated for 4 days with corticosteroid (dexamethasone 40 mg /day) and the immunosuppressive therapy was modified. Clinical status improved dramatically, with regression of the lymph nodes and the heart chambre mass on echocardiography. Serological analysis of EBV was negative. He received 2 cycles of rituximab and one per CHOP-R protocol, without the complications. Six months later PET CT showed no signs of relapse of lymphoma, and echocardiographically was seen significant regression of all changes. Findings 20 months after completion of treatment verified complete regression of disease in the heart.

Discussion: PTLD is often aggressive, rapidly progressive and potentially life threatening disease. Diffuse large B-cell lymphoma with associated tamponade in our patient required immediate treatment, therefore we did not do additional image or histopathological analysis. An excellent response to chemotherapy and complete regression testifies the fact that the rapid treatment in this case was crucial. PTLD in heart after liver transplantation has not been described, to our knowledge, and a quick and decisive evidence of disease treatment in our case resulted in a complete recovery.