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Posttransplant Lymphoproliferative Disorder Presenting as Multiple Cystic Lesions in a Renal Transplant Recipient

Lookup NU author(s): Dr Roslyn Simms, David Talbot, Dr Suren Kanagasundaram

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Abstract

We report a case of a 67-year-old man who experienced allograft dysfunction following a renal transplantation from a donation after cardiac death. The postoperative course was initially complicated by episodes of E. coli urinary sepsis causing pyrexia and a raised creatinine level. Ultrasound scanning 5 weeks posttransplant revealed mild hydronephrosis with several parenchymal cystic areas measuring up to 2 cm with appearances suggestive of fungal balls. Aspirated fluid again grew Escherichia coli, and this was treated with the appropriate antimicrobial therapy. The patient continued to have episodes of culture-negative sepsis; therefore, a computed tomography scan was performed 6 months posttransplant, which revealed multiple lesions in the renal cortex as well as liver and spleen. Subsequent biopsy revealed an EpsteinBarr virus-driven lymphoproliferation consistent with a polymorphic posttransplantation lymphoproliferative disorder (PTLD). This rare case of PTLD presenting as multiple renal, hepatic and splenic lesions emphasizes the need for a high index of clinical suspicion for this condition. Abnormal para-renal allograft masses should be biopsied to allow swift and effective management of a disease that can disseminate and become significantly more challenging to manage.

Publication metadata

Author(s): Moir JAG, Simms RJ, Wood KM, Talbot D, Kanagasundaram NS

Publication type: Article

Publication status: Published

Journal: American Journal of Transplantation

Year: 2012

Volume: 12

Issue: 1

Pages: 245-249

Print publication date: 13/01/2012

ISSN (print): 1600-6135

ISSN (electronic): 1600-6143

Publisher: Wiley-Blackwell Publishing, Inc.

URL: http://dx.doi.org/10.1111/j.1600-6143.2011.03761.x

DOI: 10.1111/j.1600-6143.2011.03761.x

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