title: Post-transplantation primary central nervous system lymphoma in a patient with systemic lupus erythematosus and prolonged use of immunosuppressant.
abstract: Post-transplantation primary central nervous system lymphoma is an uncommon and fatal post-transplant lymphoproliferative disorder. Such lymphomas have been described in only a few case series in the literature. The incidence of this condition is rising with improved survival after organ transplantation. A case of post-transplantation primary central nervous system lymphoma in a young Chinese woman with systemic lupus erythematosus is described here. She presented with right-sided weakness and memory loss after tooth extraction 2 weeks before admission. Contrast computed tomography of the brain demonstrated a contrast rim-enhancing lesion over the left frontal lobe. With a history of recent dental procedure, long-term immunosuppressive therapy and computed tomography findings, cerebral abscess was highly suspected. Emergency operation was performed. Histopathology showed post-transplantation primary central nervous system lymphoma, with cells positive for B-cell marker CD20. Immunosuppressant was stopped and she was treated with radiotherapy and rituximab (anti-CD20 monoclonal antibody). She remained disease-free at 16 months. Post-transplantation primary central nervous system lymphoma is rare with variable presentation and radiological features. We believe rituximab may have a role in the treatment of such lymphomas.
authors.affiliation: Department of Neurosurgery, Princess Margaret Hospital, Lai Chi Kok, Hong Kong.
authors.forename: Teresa P K
authors.initials: TP
authors.lastname: Tse
authors.affiliation: Department of Neurosurgery, Princess Margaret Hospital, Lai Chi Kok, Hong Kong.
authors.forename: Allan N L
authors.initials: AN
authors.lastname: Chan
authors.affiliation: Department of Neurosurgery, Princess Margaret Hospital, Lai Chi Kok, Hong Kong.
authors.forename: Tony K T
authors.initials: TK
authors.lastname: Chan
authors.affiliation: Department of Neurosurgery, Princess Margaret Hospital, Lai Chi Kok, Hong Kong.
authors.forename: Y C
authors.initials: YC
authors.lastname: Po
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D005625:Frontal Lobe; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D016030:Kidney Transplantation; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D008223:Lymphoma / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery
chemical_list: D007166:Immunosuppressive Agents
keywords: Central nervous system neoplasms; Immunosuppressive agents; Lupus erythematosus, systemic