First case report of acute myeloid sarcoma post renal transplant

Although lymphoproliferative disorders are well-described and known entities post renal transplantation, acute myeloid sarcoma is a rare if ever reported occurrence in this setting. Immunosuppressive therapy is thought to be the main culprit in these cases.

A 51-year-old man underwent renal transplantation 3.5 years earlier from a living unrelated donor. His posttransplant history was relevant for a road traffic accident after which a rise in the serum creatinine warranted 4 renal biopsies over a period of 7 months. The biopsies showed mainly acute tubular injury with sharp increase of the interstitial fibrosis and tubular atrophy between the first and the last biopsies. The patient was put on hemodialysis for 7 months, after which the allograft started functioning. The patient was followed a routinely, until he re-presented with increased creatinine and was found to have intra- and perirenal masses. Biopsies revealed acute myeloid sarcoma. The patient was started on fludarabine and cytosine arabinoside followed by All-trans retinoic acid and arsenic trioxide.

The patient was disease free on his last positron emission tomography 1 year after the initial diagnosis.