Epstein-Barr virus-positive post-transplant lymphoproliferative disorder of the central nervous system, after renal transplantation with a discrepancy in viral load between peripheral blood and cerebrospinal fluid.
A 43-year-old female developed an Epstein-Barr virus (EBV)-positive post-transplant lymphoproliferative disorder (PTLD) in the central nervous system (CNS), 14 years after renal transplantation. One year prior to presentation, the patients' treatment regimen was altered from cyclosporine, azathioprine, and prednisone to mycophenolate mofetil and prednisone. Magnetic resonance imaging of the brain revealed lesions suspect for malignant lymphoma. The EBV real-time polymerase chain reaction (PCR) on peripheral blood was negative, but highly positive on cerebrospinal fluid. EBV-positive PTLD was confirmed using histological analysis of cerebral biopsies. Despite tapering of immune suppressive medication and treatment with rituximab and chemotherapy, the patient deceased 50 days after presentation. This case illustrates that vigilance is required when presented with a negative EBV PCR result on peripheral blood when PTLD of the CNS is suspected. This late presentation suggests a relation to the switch in immunosuppressive regimen 1 year earlier.
Department of Internal Medicine, Advancet Center for Renal Disease, Vascular Medicine and Diabetes, ZGT Hospital, Almelo, The Netherlands. m.boersma@zgt.nl
Marijke Nynke
MN
Boersma
Adri
A
van der Zanden
Gozewijn Dirk
GD
Laverman
Jan Stephan
JS
Sanders
Peter Alexander Marcel
PA
de Vries
D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000821:virology*; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D017809:Fatal Outcome; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008223:Lymphoma / Q000134:cerebrospinal fluid / Q000821:virology*; D008232:Lymphoproliferative Disorders / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000821:virology*; D060888:Real-Time Polymerase Chain Reaction; D000069283:Rituximab; D019562:Viral Load
D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab