title: Post-transplant lymphoproliferative disorder of the cervical spine mimicking an epidural abscess.
abstract: Post-transplant lymphoproliferative disease (PTLD) is a recognized complication following solid organ and stem cell transplants with subsequent immunosuppression and is the most common malignancy complicating solid organ transplantation. Improved survival and use of aggressive immunosuppression following solid organ transplants have led to increased diagnosis of PTLD. Nevertheless, spinal involvement in PTLD is extremely rare. To our knowledge, this is the first report of PTLD causing epidural spinal cord compression of the cervical spine, mimicking the imaging and pathology of an epidural abscess. The patient underwent posterior and subsequent anterior decompression and stabilization. Rarity of occurrence of PTLD in the spine with absence of diagnostic imaging features may preclude differentiating it from the more commonly occurring lesions such as epidural abscess which occurs in a similar clinical setting. As the management strategy and overall prognosis are dramatically different, the importance of considering PTLD in the differential diagnosis for epidural spinal cord compression in a transplant recipient patient cannot be overemphasized.
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA. Electronic address: Joshua_T_Wewel@rush.edu.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Wewel
authors.affiliation: Department of Pathology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Aparna
authors.initials: A
authors.lastname: Harbhajanka
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Kasliwal
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA.
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Ahuja
authors.affiliation: Department of Pathology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Jerome M
authors.initials: JM
authors.lastname: Loew
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA.
authors.forename: Ricardo B
authors.initials: RB
authors.lastname: Fontes
mesh_terms: D019299:Decompression, Surgical; D003937:Diagnosis, Differential; D020802:Epidural Abscess / Q000175:diagnosis*; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects; D011379:Prognosis; D013117:Spinal Cord Compression / Q000209:etiology* / Q000601:surgery
keywords: Cervical spine; Epidural abscess; Post-transplant lymphoproliferative disorder; Spinal cord compression