Virology: EBV and transplantation: practice question

A Microbiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Microbiology · Virology: EBV and transplantation

Sample item

A renal transplant recipient on tacrolimus, mycophenolate and prednisolone develops fever and cervical lymphadenopathy 8 months after transplantation. Biopsy shows a B-cell proliferation positive for EBV-encoded RNA. What is the most appropriate first step in management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Reduce immunosuppression, with rituximab if there is no response

This is post-transplant lymphoproliferative disorder, in which impaired T-cell surveillance allows EBV-driven B-cell proliferation. The first step is reduction of immunosuppression, and rituximab or chemotherapy follows if there is no response. Antivirals are ineffective because latently infected B cells do not express viral thymidine kinase.

Option by option

  • A. Increase the tacrolimus dose

    Higher tacrolimus further suppresses T cells and would worsen proliferation.

  • B. Reduce immunosuppression, with rituximab if there is no response (correct)

    Correct. Restoring T-cell surveillance by lowering immunosuppression is the first step.

  • C. Add high-dose corticosteroids

    Corticosteroids add to immune suppression and would not control EBV-driven proliferation.

  • D. Give ganciclovir alone

    Ganciclovir needs viral thymidine kinase and does not act on latent EBV in proliferating B cells.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Microbiology questions

Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is B, Reduce immunosuppression, with rituximab if there is no response. This is post-transplant lymphoproliferative disorder, in which impaired T-cell surveillance allows EBV-driven B-cell proliferation.

Why is "Increase the tacrolimus dose" not the answer?

Higher tacrolimus further suppresses T cells and would worsen proliferation.

Why is "Add high-dose corticosteroids" not the answer?

Corticosteroids add to immune suppression and would not control EBV-driven proliferation.

Why is "Give ganciclovir alone" not the answer?

Ganciclovir needs viral thymidine kinase and does not act on latent EBV in proliferating B cells.

What concept does this question test?

It tests Virology: EBV and transplantation in Microbiology. The first step is reduction of immunosuppression, and rituximab or chemotherapy follows if there is no response. Antivirals are ineffective because latently infected B cells do not express viral thymidine kinase.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Virology: EBV and transplantation?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.