title: [Remission induced by dose-reduction of immunosuppressants alone in a patient with post-transplant lymphoproliferative disorder of central nervous system origin].
abstract: A 43-year-old male renal transplant recipient, who received a living related renal transplant 7 years ago and had been maintained with tacrolimus, mycophenolate mofetil (MMF), and prednisolone, was admitted to our hospital complaining of headache and nausea. MRI showed a large mass in the right hemisphere with ring-enhancement indicating brain abscess, tumor or lymphoma. Open biopsy was performed and pathological examination demonstrated diffuse proliferation of polymorphic cells, positive for CD20, bcl-2, EBER, and LMP-1. Based on these findings, primary central nervous system post-transplant lymphoproliferative disorder (PCNS-PTLD) was diagnosed. MMF was discontinued and tacrolimus was tapered. After 2 weeks, MRI showed regression of the tumor size and after 9 months, the tumor had disappeared. Though many reports have shown the severity of PCNS-PTLD, and recommend aggressive treatments such as chemotherapy and/or radiotherapy, our case shows that reduction of immunosuppressant alone with close observation could be a choice of treatment.
authors.affiliation: Department of Medicine, Sapporo City General Hospital, Sapporo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Minauchi
authors.forename: Kazuki
authors.initials: K
authors.lastname: Koizumi
authors.forename: Makoto
authors.initials: M
authors.lastname: Kondo
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Takigami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Harada
authors.forename: Hiromi
authors.initials: H
authors.lastname: Fujita
authors.forename: Masaya
authors.initials: M
authors.lastname: Mukai
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011239:Prednisolone / Q000008:administration & dosage; D012074:Remission Induction; D016559:Tacrolimus / Q000008:administration & dosage*
chemical_list: D007166:Immunosuppressive Agents; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus