Isolated B cell central nervous system posttransplant lymphoproliferative disorder: Role of magnetic resonance imaging in the diagnosis and management in the absence of neurological signs - a case report

• Main Authors: Monisha Jacob, Milly Mathew, Rajeevalochana Parthasarathy, Jayanthi Arulneyam, Siddartha Ghosh, Jose Easow, Sivaranjini Narayanan, Georgi Abraham
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Indian Journal of Transplantation
• Subjects: epstein–barr virus; kidney transplantation; posttransplant lymphoproliferative disease
• Online Access: http://www.ijtonline.in/article.asp?issn=2212-0017;year=2020;volume=14;issue=3;spage=243;epage=246;aulast=Jacob

A 29-year-old female who received a kidney from her mother 9 months ago, on minimal triple immunosuppression presented with short duration vertigo. There were no focal neurological deficits. Magnetic resonance imaging of the brain revealed peripherally enhancing periventricular lesions, predominantly in the bilateral frontal lobes. Positron-emission tomography showed increased uptake in the brain lesions. A stereotactic biopsy revealed CD20+ monomorphic B cell posttransplant lymphoproliferative disorder. The donor mother and daughter were Epstein–Barr virus (EBV) immunoglobulin G (IgG+)/IgG−. The cerebrospinal fluid and brain biopsy were positive for EBV. Treatment consisted of discontinuing prednisolone and MMF and reducing tacrolimus to 0.5 mg od. Rituximab, zidovudine, ganciclovir, and dexamethasone are being used. She has stable renal function.