Recurrent, Multisubtype Posttransplant Lymphoproliferative Disorder Masquerading as Inflammatory Bowel Disease.

Area of Science:

• Nephrology
• Transplantation immunology
• Oncology

Background:

• Posttransplant lymphoproliferative disorder (PTLD) is a serious complication following organ transplantation, primarily linked to immunosuppression.
• While PTLD typically manifests within the first year post-transplant, recurrent cases or those with multiple histologic subtypes are uncommon.

Observation:

• This report details a rare instance of recurrent PTLD in a renal transplant recipient.
• The patient presented with multiple histologic subtypes of PTLD (monomorphic and polymorphic) despite prior successful treatment with rituximab.
• Endoscopic examination revealed nonspecific inflammatory changes, underscoring the diagnostic challenge.

Findings:

• The case illustrates a rare recurrence of PTLD with distinct histological patterns in a renal transplant recipient.
• The patient had previously responded to rituximab, and initial endoscopic findings were non-specific, complicating early diagnosis.
• This recurrence occurred despite previous treatment and resolution of inflammatory signs.

Implications:

• Clinicians must maintain a high index of suspicion for PTLD in all transplant recipients, irrespective of prior treatment or endoscopic appearance.
• A lower threshold for performing biopsies is crucial when encountering nonspecific inflammatory changes during endoscopy in this patient population.
• Early and accurate diagnosis of recurrent PTLD with diverse subtypes is vital for appropriate management and improved patient outcomes.