Epstein-Barr Virus; Epstein-Barr Virus infections; EBV; post-transplant lymphoproliferative disorders; PTLD; spironolactone


Infectious Disease


Epstein Barr Virus (EBV) may cause lymphoproliferative disorder that can cause malignancies in patients who are immunosuppressed. These malignancies may be suppressed or reversed by antiviral therapy including spironolactone.

We present a case of a 66-year-old female who had been immunosuppressed through use of interferon and tumor necrosis factor (TNF)-active agents for multiple sclerosis (MS). She met the criteria for idiopathic CD4 T-lymphocytopenia or non-human immunodeficiency syndrome (HIV) acquired immunodeficiency syndrome (AIDS). She developed a reactivation of EBV due to the immunosuppression which caused a subset of Non-Hodgkin’s lymphoma. The patient was initially treated with valacyclovir but she developed brain lesions of lymphoma and was therefore switched to ganciclovir, after which the EBV viral load decreased. A year later her brain lesions relapsed. Therefore, she was placed on spironolactone in addition to ganciclovir, which successfully controlled the virus and prevented further relapse.

This case demonstrates spironolactone’s ability to suppress EBV replication and assist with prophylaxes against EBV in high-risk patients undergoing solid organ transplant or immunosuppressed patients, hence limiting complications.