A Case of Post-Transplantation Lymphoproliferative Disorder Following Kidney Transplantation

This was a case of a 65-year-old gentleman known to have diabetes mellitus and hypertension since 2012 and post renal transplantation in 2016. He had also been treated for hepatitis C infection in the past. His regular medications included nebivolol 5 mg once a day, tacrolimus 4 mg twice a day, mycophenolate mofetil 500 mg twice a day, prednisolone 5 mg once a day, and insulin-novomix 14 units in the morning and 6 units at night. He presented to a tertiary teaching hospital in Kenya in October 2023 with abdominal pain, vomiting, and constipation on and off for 6 months, worse in the month prior to presentation. His examination was positive for dehydration, abdominal distension, and generalized abdominal tenderness. He had a normal hematological profile and renal function. A CT scan of the abdomen showed features of small bowel obstruction from the distal ileal to distal jejunal bowel loops. The patient underwent an exploratory laparotomy with intraoperative findings of a midjejunal tumor completely obstructing the lumen with proximal dilatation. The tumor was subsequently excised. Histological specimen confirmed diffuse large B-cell lymphoma (DLBCL) as his final diagnosis.