Suspicion For Post-transplant Lymphoproliferative Disorder Research Articles

Cat-scratch disease masquerading as post-transplant lymphoproliferative disorder

Abstract Lymphadenopathy in an immunosuppressed patient raises the quintessential diagnostic dilemma: infection or malignancy? We present the case of a transplant recipient on anti-rejection prophylaxis admitted with acute fever, malaise and a swollen right axillary node. The patient had pancytopenia and tested positive for Epstein–Barr virus; nodal core biopsy demonstrated atypical plasma cell infiltration, immediately raising suspicion for post-transplant lymphoproliferative disorder. However, excisional biopsy and Bartonella henselae serology clarified a final diagnosis of cat-scratch disease—a potentially fatal zoonosis requiring a disparate treatment regimen. Here, we explore this patient’s investigations, hospital course and recovery, with an emphasis on recognizing and differentiating these diagnostic mimics in post-transplant practice.

18 F-FDG PET/CT in Renal Allograft Tuberculosis Mimicking as Posttransplant Malignancy.

The most common complications after the renal transplant are infections and malignancies, including posttransplant lymphoproliferative disorders. Tubercular infection in renal allograft recipients is a relatively rare entity. However, nonspecific constitutional symptoms often delay diagnosis, leading to significant morbidity and mortality. We present the 18 F-FDG PET/CT findings in a patient with renal allograft tuberculosis who had clinical and imaging suspicion of posttransplant lymphoproliferative disorder or renal cell carcinoma. Histopathology from the renal lesion revealed tuberculosis.

Ocular post-transplant lymphoproliferative disorder

We report a case of an iris tumor with mutton-fat keratic precipitates in a young patient after liver transplantation surgery. A 6-year-old girl underwent liver transplantation for congenital biliary atresia and was subsequently immunosuppressed with oral cyclosporine. We examined her 5 years after transplantation because of a “white nodule in her left eye,” which had been detected by her father one day before visiting our clinic. Ophthalmological examinations revealed symmetric visual acuity and normal afferent papillary reflex. Slit-lamp examination revealed a depigmented iris nodule approximately3 × 2 mm with mutton-fat keratic precipitates in the anterior chamber. Fundus examination was unremarkable, and computed tomography (CT) of the head, neck, and abdomen showed normal findings. Based on the suspicion of post-transplant lymphoproliferative disorder (PTLD), therapy was initiated, which included tapering cyclosporine and topical mydriatics. After 2.5 months, the lesion resolved and no more mutton-fat keratic precipitates were identified in the anterior chamber. In this PTLD case, the patient presented with an iris nodule and mutton-fat keratic precipitates, and the ocular PTLD presentation resolved spontaneously after tapering cyclosporine.