title: Posttransplant lymphoproliferative disorder presenting as multiple cystic lesions in a renal transplant recipient.
abstract: We report a case of a 67-year-old man who experienced allograft dysfunction following a renal transplantation from a donation after cardiac death. The postoperative course was initially complicated by episodes of E. coli urinary sepsis causing pyrexia and a raised creatinine level. Ultrasound scanning 5 weeks posttransplant revealed mild hydronephrosis with several parenchymal cystic areas measuring up to 2 cm with appearances suggestive of fungal balls. Aspirated fluid again grew Escherichia coli, and this was treated with the appropriate antimicrobial therapy. The patient continued to have episodes of culture-negative sepsis; therefore, a computed tomography scan was performed 6 months posttransplant, which revealed multiple lesions in the renal cortex as well as liver and spleen. Subsequent biopsy revealed an Epstein-Barr virus-driven lymphoproliferation consistent with a polymorphic posttransplantation lymphoproliferative disorder (PTLD). This rare case of PTLD presenting as multiple renal, hepatic and splenic lesions emphasizes the need for a high index of clinical suspicion for this condition. Abnormal para-renal allograft masses should be biopsied to allow swift and effective management of a disease that can disseminate and become significantly more challenging to manage.
authors.affiliation: Renal Transplant Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK. john.moir@nuth.nhs.uk
authors.forename: J A G
authors.initials: JA
authors.lastname: Moir
authors.forename: R J
authors.initials: RJ
authors.lastname: Simms
authors.forename: K M
authors.initials: KM
authors.lastname: Wood
authors.forename: D
authors.initials: D
authors.lastname: Talbot
authors.forename: N S
authors.initials: NS
authors.lastname: Kanagasundaram
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004927:Escherichia coli Infections / Q000188:drug therapy; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000209:etiology*; D008297:Male
chemical_list: D000900:Anti-Bacterial Agents