Secondary Epstein-Barr virus associated lymphoproliferative disorder developing in a patient with angioimmunoblastic T cell lymphoma on vorinostat.

Ebstein-Barr Virus (EBV)-related lymphoproliferative disorders primarily occur in the setting of immunosuppression, most commonly after solid organ transplantation. The frequency depends on the degree of immunosuppression and the specific organ transplanted, but can be as high as 3–9% in heart or lung transplant patients. Less frequent outside of the transplant setting, EBV-related lymphoproliferative disorders classified as other iatrogenic immunodeficiency associated lymphoproliferative disorders in the WHO Classification, which are different than iatrogenically related lymphomas supervening on hematological malignancies, have been associated with other immunosuppressive therapies such as 6-Mercaptopurine, azathioprine, or alemtuzumab. These disorders have also been reported to develop spontaneously in patients with T cell lymphomas (angioimmunoblastic and peripheral T cell NOS). Here we report the case of a patient with an angioimmunoblastic T cell lymphoma on therapy with vorinostat who developed an EBV related B-cell lymphoproliferative disorder involving bilateral adrenal glands. Angioimmunoblastic T cell lymphoma is associated with severe immunodeficiency and risk for opportunistic infections. This immune dysregulation has been implicated in its association with EBV related lymphoproliferative disorders. In this patient, vorinostat therapy also appears to be linked to the development of an EBV-related lymphoproliferative disorder.