Acute myelo-monocytic infiltrate of the lower esophagus in a 4-year-old renal transplant recipient.
BACKGROUND
Acute myeloid leukemia after solid organ transplantation is a rare phenomenon. Few achieve remission; most succumb to relapse and infection.


METHODS
A 4-year-old male renal transplant recipient on triple immunosuppression had culture-negative high spiking fever, persistent leukopenia, anemia and severe gastritis. Upper endoscopy showed 2 ulcerating masses in the lower esophagus.


RESULTS
Esophageal biopsy showed a highly atypical myelo-monocytic infiltrate. A blastic population of cells featuring convoluted nuclear envelopes with an open chromatin pattern and abundant cytoplasm were filling the submucosa and infiltrating into the muscularis propria. Extensive investigation including bone marrow aspiration showed no spread. Drastic reduction of immunosuppression except 4-mg/d (0.22 mg/kg/d) prednisone for 2 to 3 weeks led to resolution of the leukemic process proven on repeat biopsy. The patient still is in remission 2 years later.


CONCLUSIONS
This case provides evidence that early diagnosis and aggressive reduction of immunosuppression may remit a posttransplant locally invasive acute myelo-monocytic infiltrative process.
Dixit
Mehul P
MP
Department of Pediatrics, Section of Nephrology, Steele Memorial Children's Research Center, Tucson, AZ 85724, USA. mdixit@peds.arizona.edu
Farias
Katherine B
KB
McQuade
Marjorie
M
Scott
Katherine M
KM
D001706:Biopsy; D002675:Child, Preschool; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D007948:Leukemia, Monocytic, Acute / Q000209:etiology* / Q000473:pathology; D015470:Leukemia, Myeloid, Acute / Q000209:etiology* / Q000473:pathology; D008297:Male; D012074:Remission Induction; D012307:Risk Factors