title: Posttransplantation lymphoproliferative disorder presenting as a unilateral leg mass 10 years after kidney transplantation.
abstract: Epstein-Barr virus (EBV)-associated lymphoproliferative disorder is a well-known complication of solid organ transplantation. The risk factors include type and degree of immunosuppression and EBV status of the donor and recipient before transplantation. The manifestations of posttransplantation lymphoproliferative disorders are myriad, from subtle findings such as tonsillar hypertrophy to fulminant manifestations such as hepatocellular failure and death. Here we report an unusual presentation of posttransplantation lymphoproliferative disorder as unilateral leg swelling in a 68-year-old man 10 years after kidney transplantation. The patient had detectable EBV-DNA by polymerase chain reaction in the peripheral blood and EBV messenger RNA by in situ hybridization in biopsy tissue. The patient's tumor did not respond to reductions in immunosuppressive medication, intravenous immunoglobulin, ganciclovir, and rituximab. Eventually the patient responded to CHOP (cyclophosphamide, Oncovin [vincristine, Eli Lilly, Indianapolis, IN], prednisone, and doxorubicin) therapy. He is currently 2 years posttreatment, with a serum creatinine of 0.8 mg/dL, on no immunosuppression.
authors.affiliation: Center for Kidney Transplantation, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. bunnapradist@cshs.org.
authors.forename: Suphamai
authors.initials: S
authors.lastname: Bunnapradist
authors.forename: Ashley
authors.initials: A
authors.lastname: Vo
authors.forename: Mieko
authors.initials: M
authors.lastname: Toyoda
authors.forename: Randa
authors.initials: R
authors.lastname: Alsabeh
authors.forename: Christopher
authors.initials: C
authors.lastname: Lockhart
authors.forename: Dechu
authors.initials: D
authors.lastname: Puliyanda
authors.forename: Stanley C
authors.initials: SC
authors.lastname: Jordan
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000209:etiology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016030:Kidney Transplantation; D007866:Leg; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D013997:Time Factors; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone