Late-Onset Post-transplantation Central Nervous System Lymphoproliferative Disorder: Case Report.

Area of Science:

• Oncology
• Virology
• Nephrology

Background:

• Post-transplantation lymphoproliferative disorder (PTLD) arises from immunosuppression following organ transplantation.
• Central nervous system (CNS)-PTLD is a rare but increasingly recognized complication, particularly in kidney transplant recipients.
• Epstein-Barr virus (EBV) is frequently implicated in the development of CNS-PTLD.

Observation:

• A 77-year-old male kidney transplant recipient presented with new-onset seizures 14 years post-transplant.
• Magnetic resonance imaging (MRI) was contraindicated due to a pacemaker.
• Diagnosis was confirmed via brain biopsy, with EBV detected in biopsy, cerebrospinal fluid, and blood.

Findings:

• The patient received maintenance immunosuppression with mycofenolate mofetil (MMF), cyclosporine, and prednisolone.
• Treatment involved immunosuppression reduction and switching cyclosporine to sirolimus.
• The patient's condition was poor, and he died before rituximab administration.

Implications:

• Increased awareness of neurological symptoms in kidney transplant patients is vital for early CNS-PTLD diagnosis.
• Contrasted brain computed tomography (CT) can be a valuable diagnostic tool when MRI is not feasible.
• Timely diagnosis and intervention are critical for improving outcomes in CNS-PTLD.