Srpski arhiv za celokupno lekarstvo 2016 Volume 144, Issue 5-6, Pages: 325-328
https://doi.org/10.2298/SARH1606325L
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Early post-transplant lymphoproliferative disorder - case of fatal lymphoma after kidney transplantation
Laušević Mirjana (Clinical Center of Serbia, Clinic of Nephrology, Belgrade + School of Medicine, Belgrade)
Markovic-Lipkovski Jasmina (School of Medicine, Belgrade + School of Medicine, Institute of Pathology, Belgrade)
Terzić Tatjana (School of Medicine, Belgrade + School of Medicine, Institute of Pathology, Belgrade)
Jovanović Nataša (Clinical Center of Serbia, Clinic of Nephrology, Belgrade)
Milinković Marija (Clinical Center of Serbia, Clinic of Nephrology, Belgrade)
Naumović Radomir (Clinical Center of Serbia, Clinic of Nephrology, Belgrade + School of Medicine, Belgrade)
Introduction. Post-transplant lymphoproliferative disorder (PTLD) is a common
malignancy following organ transplantation. Risk for PTLD is associated with
the use of anti-thymocyte globulin in the prevention and treatment of acute
rejection following kidney transplantation. Case Outline. We report a case of
fatal PTLD presented with sudden onset of fever. A 33-year-old male patient
with primary diagnosis of left kidney agenesia underwent kidney
transplantation six years following hemodialysis treatment initiation.
Deceased donor was a 66-year-old female whose cause of death was
cerebrovascular accident. Immunosuppressive regimen consisted of basiliximab,
corticosteroids, tacrolimus, and mycophenolate mofetil. Six months upon
transplantation the patient was hospitalized due to fever of unknown origin.
All microbiological samples were negative, but abdominal ultrasound revealed
round solid mass in the right native kidney. Right nephrectomy was performed
showing tumor 35 x 35 x 20 mm in size within the 70 x 40 x 35 mm kidney.
Pathohistological analysis confirmed very rare monomorphic B-cell PTLD -
B-cell lymphoma, unclassifiable, with features intermediate between diffuse
large B-cell lymphoma and classical Hodgkin lymphoma. Conclusion. We consider
this case of PTLD following kidney transplantation particular because of the
tumor mass in native kidney after basiliximab induction and rare
pathohistology. In a transplanted patient with fever, PTLD must always be
considered, irrespective of immunosuppressive regimen.
Keywords: kidney transplantation, post-transplant lymphoproliferative disorder, immunosuppression, fatal outcome