Late Primary B Cell Cerebral Lymphoma After Kidney Transplant: A Case Report and Literature Review

Abstract

Background: Primary central nervous system post-transplant lymphoproliferative disorder (PCNS-PTLD) is a serious and uncommon complication which can be developed months or years after a Kidney transplant. Immunosuppressive agents administered before and after transplantation to minimize the chances of allograft rejection has proved to be a double-edged sword that puts the host at risk of infectious, neoplastic and vascular diseases, including PCNS-PTLD. The immunosuppressive therapy leads to decreased innate malignant and viral immune surveillance and this has been shown to play a role in lymphoproliferative diseases after transplantation. In most cases, PCNS-PTLD is Epstein–Barr virus related. Case Description: A 60-year-old female with history of kidney transplant presented to the emergency room with history of low fever, dizziness nausea and vomiting for 1 month. MRI and CT scans showed a mass cerebellar lesion and a biopsy revealed Primary central nervous system post-transplant lymphoproliferative disorder (PCNS-PTLD). Conclusion: This case highlights the need for a careful long-term follow up of patients with kidney transplant. PCNS-PTLD represents a continuing long-term risk after transplantation, although less common. This case report supports observational data that suggests that peripheral blood screening for EBV DNA does not seem helpful for identification of PCNS-PTLD. Suspicion of PCNS PTLD should be considered when patients with long-term history of kidney transplant present neurological complaints.