title: Successful treatment of monomorphic primary central nervous system post-transplantation lymphoproliferative disorder 5 years after kidney transplantation.
abstract: A 31-year-old man underwent living-related kidney transplantation in 2004 as a consequence of primary focal segmental glomerulosclerosis (FSGS). Four years after the transplantation, we confirmed nephrotic syndrome caused by recurrent FSGS. We performed plasmapheresis and low-density lipoprotein adsorption. We also combined steroid therapy with a reduction in the dose of tacrolimus and an increased dose of mycophenolate mofetil. The nephrotic syndrome improved dramatically with this combined therapeutic approach. However, 10 months after these treatments, he revisited our hospital because of altered consciousness. We detected multiple tumor masses in his brain that were ring enhanced on contrast magnetic resonance imaging. Consequently, we suspected primary central nervous system post-transplantation lymphoproliferative disorder (CNS-PTLD). We performed a craniotomy to biopsy the brain tumors. The biopsy specimen showed Epstein-Barr virus-associated diffuse large B-cell lymphoma. There is no definitive treatment for CNS-PTLD. Therefore, we treated the primary CNS-PTLD successfully with whole-brain radiation and discontinuation of immunosuppression therapy.
authors.affiliation: Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan. t-yaginuma@f00.itscom.net
authors.forename: T
authors.initials: T
authors.lastname: Yaginuma
authors.forename: H
authors.initials: H
authors.lastname: Yamamoto
authors.forename: J
authors.initials: J
authors.lastname: Mitome
authors.forename: Y
authors.initials: Y
authors.lastname: Tanno
authors.forename: I
authors.initials: I
authors.lastname: Yamamoto
authors.forename: A
authors.initials: A
authors.lastname: Kobayashi
authors.forename: A
authors.initials: A
authors.lastname: Mafune
authors.forename: H
authors.initials: H
authors.lastname: Hayakawa
authors.forename: K
authors.initials: K
authors.lastname: Yokoyama
authors.forename: R
authors.initials: R
authors.lastname: Mori
authors.forename: H
authors.initials: H
authors.lastname: Ohashi
authors.forename: N
authors.initials: N
authors.lastname: Kaito
authors.forename: T
authors.initials: T
authors.lastname: Joki
authors.forename: J
authors.initials: J
authors.lastname: Miki
authors.forename: H
authors.initials: H
authors.lastname: Yamada
authors.forename: N
authors.initials: N
authors.lastname: Furuta
authors.forename: S
authors.initials: S
authors.lastname: Matsushima
authors.forename: T
authors.initials: T
authors.lastname: Fukuda
authors.forename: T
authors.initials: T
authors.lastname: Hosoya
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002493:Central Nervous System Diseases / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D011859:Radiography; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents