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Diagnostic delay can occur because PBL overlaps immunologic markers and cytology with plasmacytic myeloma, although bone marrow involvement and associated laboratory features support myeloma. Treatment options remain limited with poor outcomes; intensive regimens such as EPOCH, sometimes combined with myeloma-directed agents including bortezomib and daratumumab, are used. A 54-year-old post-cardiac transplant patient with biopsy findings suggestive of both PBL and plasmacytic myeloma was treated with rituximab plus EPOCH, bortezomib, and daratumumab.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-rare-case-of-plasmablastic-lymphoma-with-difficult-diagnosis-and-treatment-in-a-cardiac-transplant-patient/437328/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-rare-case-of-plasmablastic-lymphoma-with-difficult-diagnosis-and-treatment-in-a-cardiac-transplant-patient/437328.png","ImageObject",300,407,{"name":92,"@type":93},"eBook King","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is plasmablastic lymphoma difficult to diagnose in post-transplant patients?","Question",{"text":113,"@type":114},"PBL can mimic plasmacytic myeloma because both share immunological markers and cytological characteristics, which can lead to diagnostic uncertainty and delay.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What laboratory or clinical clues help differentiate PBL from plasmacytic myeloma?",{"text":118,"@type":114},"Myeloma typically involves the bone marrow and may show paraproteinemia, renal disease, and hypercalcemia; careful biopsy review supports separation from PBL. EBV and HIV status in most PBL cases can also aid differentiation.",{"name":120,"@type":111,"acceptedAnswer":121},"What treatment regimen was used in this cardiac transplant case?",{"text":122,"@type":114},"The patient was treated with rituximab combined with the EPOCH regimen, along with bortezomib and daratumumab.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},437328,1790904047,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962088006270,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Review began 08/07/2025  \nReview ended 11/28/2025  \nPublished 12/04/2025  \n© Copyright 2025  \nGul et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98480  \nOpen Access Case Report  \nA Rare Case of Plasmablastic Lymphoma With Difficult Diagnosis and Treatment in a Cardiac Transplant Patient  \nOwais Gul 1, Muhammad Abdul Basit 1 , Saqib Gul 2, Obuli Srinivasan Gurunathan 1 , Maria Khalid 1  \n1. Internal Medicine, United Health Services Wilson Medical Center, Johnson City, USA 2. Internal Medicine, Hamdard College of Medicine and Dentistry, Karachi, PAK  \nCorresponding author: Owais Gul, [owaisgul96@yahoo.com](owaisgul96@yahoo.com)  \nAbstract  \nPlasmablastic lymphoma (PBL) is a rare lymphoproliferative disease that can affect immunocompromised post-transplant patients. Patients with positive human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) status are at high risk. PBL shares many immunological markers and cytological characteristics  \nwith plasmacytic myeloma, which can lead to uncertainty and delay in diagnosis. However, myeloma typically involves the bone marrow, and the presence of other laboratory findings in myeloma, such as paraproteinemia, renal disease, and hypercalcemia, along with careful review of the biopsy, may help to distinguish between the two conditions. Treatment options are limited with poor prognosis and survival ; however, intensive chemotherapy regimens such as EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) are often used, sometimes in combination with agents that are being traditionally used in the treatment of myeloma, such as bortezomib and daratumumab. Here, we describe the case of a 54-year-old male patient who developed post-transplant lymphoproliferative disorder (PTLD) after undergoing cardiac transplantation with biopsy findings suspicious for both PBL and plasmacytic myeloma and treated with rituximab plus the EPOCH regimen, bortezomib, and daratumumab.  \nCategories: Hematology, Transplantation, Oncology  \nKeywords: bone marrow, bortezomib, daratumumab, epoch, epstein-barr virus, hiv, plasmablastic lymphoma (pbl), plasmacytic myeloma, post-transplant lymphoproliferative disorder  \nIntroduction  \nPlasmablastic lymphoma (PBL) is a rare and aggressive B-cell lymphoma that primarily affects immunocompromised individuals, including those with human immunodeficiency virus (HIV) or solid organ transplants. It is characterized by the proliferation of immature plasma cells and has a poor prognosis. The neoplastic cells exhibit a high proliferation index, characterized by the presence of plasma cell markers and the absence or minimal expression of B-cell markers [1] . Distinguishing between the post-transplant lymphoproliferative disorders (PTLDs) can be challenging due to the overlapping clinical presentations and immunological profiles. One such entity is plasmacytic myeloma, which shares many immunological markers and cytological characteristics with PBL. However, involvement of the bone marrow in myeloma and positivity status for Epstein-Barr virus (EBV) or HIV in the majority of PBL cases may help in the differentiation between the two conditions [2] . This case is unique due to the manifestation of PBL in a cardiac transplant patient, which is of particularly rare occurrence given the relatively low number of such transplants compared to other solid organ transplants.  \nCase Presentation  \nA 54-year-old man presented to the emergency department with complaints of shortness of breath on exertion for the past seven days. His past medical history was significant for iron deficiency anemia, dyslipidemia, and generalized anxiety disorder. He also underwent an orthotopic heart transplant in the past (about 10 months ago) due to a history","cbCaihhNwiZV4HbH","https://ap.wps.com/l/cbCaihhNwiZV4HbH","pdf",1233515,"English","# Abstract\n# Introduction\n# Case Presentation\n## Emergency department presentation\n## Laboratory and serology findings\n## Imaging and PTLD suspicion","[{\"question\":\"Why is plasmablastic lymphoma difficult to diagnose in post-transplant patients?\",\"answer\":\"PBL can mimic plasmacytic myeloma because both share immunological markers and cytological characteristics, which can lead to diagnostic uncertainty and delay.\"},{\"question\":\"What laboratory or clinical clues help differentiate PBL from plasmacytic myeloma?\",\"answer\":\"Myeloma typically involves the bone marrow and may show paraproteinemia, renal disease, and hypercalcemia; careful biopsy review supports separation from PBL. EBV and HIV status in most PBL cases can also aid differentiation.\"},{\"question\":\"What treatment regimen was used in this cardiac transplant case?\",\"answer\":\"The patient was treated with rituximab combined with the EPOCH regimen, along with bortezomib and daratumumab.\"}]","A Rare Case of Plasmablastic Lymphoma With Difficult Diagnosis and Treatment in a Cardiac Transplant Patient | PDF",1790681092,13]