BACKGROUND: Primary central nervous system (PCNS) post-transplant lymphoproliferative disorder (PTLD) is a rare complication of solid organ transplantation and is typically an Epstein-Barr virus (EBV)-induced B-cell CD20+ lymphoma. The modalities of treatment include reduction in immunosuppression, cranial radiotherapy (CRT), intravenous and intrathecal rituximab when CD20 is expressed on B-lymphocytes and PTLD cells, and chemotherapy. CASE-DIAGNOSIS/TREATMENT: We report the successful treatment of EBV-driven PCNS PTLD by reduction in immunosuppression (RI), CRT, and intravenous rituximab. Our patient was an 11-year-old boy with a living-related renal transplant for end-stage renal failure (ESRF) secondary to posterior urethral valves (PUV) and bilateral renal dysplasia (BRD) and on triple immunosuppression with prednisolone, tacrolimus, and azathioprine who had a rising EBV load, which was managed with reduction in tacrolimus dose, withdrawal of azathioprine, and introduction of mycophenolate mofetil (MMF). CONCLUSIONS: The patient presented 7 years post-transplant with a seizure and abnormal neurology secondary to polymorphous hyperplastic lesions in the brain, which responded to rituximab and CRT.
BACKGROUND:Primary central nervous system (PCNS) post-transplant lymphoproliferative disorder (PTLD) is a rare complication of solid organ transplantation and is typically an Epstein-Barr virus (EBV)-induced B-cell CD20+ lymphoma. The modalities of treatment include reduction in immunosuppression, cranial radiotherapy (CRT), intravenous and intrathecal rituximab when CD20 is expressed on B-lymphocytes and PTLD cells, and chemotherapy. CASE-DIAGNOSIS/TREATMENT: We report the successful treatment of EBV-driven PCNS PTLD by reduction in immunosuppression (RI), CRT, and intravenous rituximab. Our patient was an 11-year-old boy with a living-related renal transplant for end-stage renal failure (ESRF) secondary to posterior urethral valves (PUV) and bilateral renal dysplasia (BRD) and on triple immunosuppression with prednisolone, tacrolimus, and azathioprine who had a rising EBV load, which was managed with reduction in tacrolimus dose, withdrawal of azathioprine, and introduction of mycophenolate mofetil (MMF). CONCLUSIONS: The patient presented 7 years post-transplant with a seizure and abnormal neurology secondary to polymorphous hyperplastic lesions in the brain, which responded to rituximab and CRT.
Authors: S H K Oertel; E Verschuuren; P Reinke; K Zeidler; M Papp-Váry; N Babel; R U Trappe; S Jonas; M Hummel; I Anagnostopoulos; B Dörken; H B Riess Journal: Am J Transplant Date: 2005-12 Impact factor: 8.086
Authors: D E Tsai; C L Hardy; J E Tomaszewski; R M Kotloff; K M Oltoff; B G Somer; S J Schuster; D L Porter; K T Montone; E A Stadtmauer Journal: Transplantation Date: 2001-04-27 Impact factor: 4.939
Authors: C Cameron Yin; L Jeffrey Medeiros; Lynne V Abruzzo; Dan Jones; Anwar I Farhood; Vilmos A Thomazy Journal: Am J Clin Pathol Date: 2005-02 Impact factor: 2.493
Authors: R Purighalla; R Shapiro; M L Jordan; V P Scantlebury; H A Gritsch; C Vivas; P S Randhawa Journal: Clin Transplant Date: 1997-12 Impact factor: 2.863
Authors: Amilcar A Castellano-Sanchez; Shiyong Li; Jiang Qian; Anand Lagoo; Edward Weir; Daniel J Brat Journal: Am J Clin Pathol Date: 2004-02 Impact factor: 2.493