EBV-associated leukoencephalopathy with late onset of central nervous system lymphoma in a kidney transplant recipient.
Central nervous system (CNS) lymphoma is a rare posttransplant lymphoproliferative disorder (PTLD), which usually has a poor outcome. To date, no specific conditions predisposing to this complication have been identified. We here describe the case of a renal transplant patient who was initially diagnosed as having Epstein-Barr virus (EBV)-associated leukoencephalopathy and ultimately developed EBV-positive CNS lymphoma. The patient was a young lady who, 2 years after transplantation, presented with focal neurological and electroencephalographic abnormalities and diffuse white matter lesions on brain magnetic resonance imaging. EBV-DNA was detected in the cerebrospinal fluid (CSF) by polymerase chain reaction. After acyclovir therapy and immunosuppressive drug tapering, the symptoms and electroencephalographic abnormalities subsided, and EBV-DNA disappeared from the CSF. Ten years later, a bulky cerebral mass was found. After excision, a diagnosis of EBV-positive, Hodgkin-like monomorphic B-cell PTLD was made. This case illustrates the potential pathophysiological relationships between EBV infection, leukoencephalopathy and CNS lymphoma; although a long time elapsed from the initial neurological illness to CNS lymphoma, a link between these two conditions cannot be excluded. Therefore, a careful long-term follow-up of EBV-related encephalopathy is advisable.
Vaglio
A
A
Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma, Parma, Italy.
Manenti
L
L
Division of Nephrology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Mancini
C
C
Department of Pathology and Laboratory Medicine, Section of Pathology, University of Parma, Italy.
Chierici
E
E
Division of Neurology, Vaio Hospital, Fidenza, Italy.
Cobelli
R
R
Department of Radiology, University of Parma, Parma, Italy.
Bacci
F
F
Institute of Hematology and Clinical Oncology 'L. and A. Seràgnoli', S.Orsola-Malpighi Hospital, Bologna, Italy.
Palmisano
A
A
Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma, Parma, Italy.
Buzio
C
C
Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma, Parma, Italy.
Bignardi
L
L
Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma, Parma, Italy.
Maggiore
U
U
Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma, Parma, Italy.
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D005260:Female; D004854:Herpesvirus 4, Human / Q000472:pathogenicity*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D056784:Leukoencephalopathies / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D008223:Lymphoma / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D008279:Magnetic Resonance Imaging; D049268:Positron-Emission Tomography; D014412:Tumor Virus Infections / Q000175:diagnosis* / Q000628:therapy
D000998:Antiviral Agents