ESPN 51th Annual Meeting

ESPN 2018


 
PTLD OF CENTRAL NERVOUS SYSTEM: A FATAL COMPLICATION AFTER RENAL TRANSPLANTATION
MUSTAFA KOYUN 1 ELIF COMAK 1 ELIF GULER 2 KAMIL KARAALI 3 GUZIDE AYSE OCAK 4 SEMA AKMAN 1

1- AKDENIZ UNIVERSITY, MEDICAL FACULTY, DEPARTMENT OF PEDIATRICS, DIVISION OF PEDIATRIC NEPHROLOGY, ANTALYA, TURKEY
2- AKDENIZ UNIVERSITY, MEDICAL FACULTY, DEPARTMENT OF PEDIATRICS, DIVISION OF PEDIATRIC ONCOLOGY, ANTALYA, TURKEY
3- AKDENIZ UNIVERSITY, MEDICAL FACULTY, DEPARTMENT OF RADIOLOGY, ANTALYA, TURKEY
4- AKDENIZ UNIVERSITY, MEDICAL FACULTY, DEPARTMENT OF PATHOLOGY, ANTALYA, TURKEY
 
Introduction:

Post-transplant lymphoproliferative disease (PTLD) is a rare, but severe complication of transplantation. Here, we present a renal transplant recipient, who developed PTLD at central nervous system.

Material and methods:

A 13 year old girl with a diagnosis of FSGS underwent pre-emptive renal transplantation from a living donor. She was EBV seronegative. She received tacrolimus, MMF and prednisolone for immunosupresive therapy. The first year of transplantation was uneventful.

Results:

12 months after tx, she presented with headache and vomiting lasting for two months. She was living far from our center; definitive diagnosis could not be made at local hospital. Neurologic examination was unremarkable. A cranial MRI showed two lesions, one at right frontal lobe and the other at left parietal lobe with a diameter of 22x20 and 27x20 mm, respectively. EBV PCR was 4250 copies/mL, which increased to 25.695 copies/mL two weeks later. A lomber punction was performed; protein 61 g/dL, glucose 60 mg/dL, a few lymphocytes were seen, EBV PCR at cerebro-spinal fluid was positive (721 copies/mL). A brain biopsy showed CD20,CD45 and EBV positive neoplastic lymphocytes compatible with diffuse large B-cell lymphoma. On PET-BT, no lesion was seen on abdomen or thorax. No involvement was detected on bone marrow aspiration. The tumours was excised. Immunosupresive agents were stopped. A chemotherapy regimen for lymphoma (LMB 96) and rituximab was given. However, one month after her approval, she died.

Conclusions:

Persistent and unexplained complaints in a EBV seronegative renal transplant recipient should raise high index of suspicion of PTLD, a potentially fatal complication of transplantation.