TY - JOUR
T1 - Post-transplant lymphoproliferative disorder of the cauda equina in a kidney transplant recipient
AU - Nishiyama, Yuichiro
AU - Iwanami, Akio
AU - Mikami, Shuji
AU - Kawabata, Soya
AU - Tsuji, Osahiko
AU - Nagoshi, Narihito
AU - Okada, Eijiro
AU - Fujita, Nobuyuki
AU - Yagi, Mitsuru
AU - Ishii, Ken
AU - Matsumoto, Morio
AU - Nakamura, Masaya
AU - Watanabe, Kota
N1 - Publisher Copyright:
© 2018, International Spinal Cord Society.
PY - 2018/12
Y1 - 2018/12
N2 - Introduction: Post-transplant lymphoproliferative disorder (PTLD) is a condition associated with post-transplant immunosuppression that can develop in various organs, including the grafted one. However, it has rarely been reported in nerve tissue. We encountered an unexpected case of PTLD in the cauda equina of a kidney transplant recipient who was being treated with chronic immunosuppressive therapies. Case presentation: The patient was a 39-year-old woman in whom lower limb muscle weakness appeared and progressed rapidly 10 years after kidney transplantation for glomerulonephritis. Magnetic resonance imaging (MRI) findings were suggestive of an intradural extramedullary tumor. Diagnosis of PTLD was established on open biopsy. Culprit immunosuppressants (tacrolimus, mycophenolate mofetil, and prednisolone) were discontinued, and rituximab and radiation therapy were started. The paraplegia gradually improved after drug discontinuation, and the lesion diminished in size 3 months after this series of treatment, and finally disappeared on MRI as of 1 year after treatment. Discussion: PTLD in the cauda equina is extremely rare, and only one case involving the cauda equina has been reported previously. Biopsy should be performed initially for definitive diagnosis, after which the suspected culprit immunosuppressants should be immediately discontinued.
AB - Introduction: Post-transplant lymphoproliferative disorder (PTLD) is a condition associated with post-transplant immunosuppression that can develop in various organs, including the grafted one. However, it has rarely been reported in nerve tissue. We encountered an unexpected case of PTLD in the cauda equina of a kidney transplant recipient who was being treated with chronic immunosuppressive therapies. Case presentation: The patient was a 39-year-old woman in whom lower limb muscle weakness appeared and progressed rapidly 10 years after kidney transplantation for glomerulonephritis. Magnetic resonance imaging (MRI) findings were suggestive of an intradural extramedullary tumor. Diagnosis of PTLD was established on open biopsy. Culprit immunosuppressants (tacrolimus, mycophenolate mofetil, and prednisolone) were discontinued, and rituximab and radiation therapy were started. The paraplegia gradually improved after drug discontinuation, and the lesion diminished in size 3 months after this series of treatment, and finally disappeared on MRI as of 1 year after treatment. Discussion: PTLD in the cauda equina is extremely rare, and only one case involving the cauda equina has been reported previously. Biopsy should be performed initially for definitive diagnosis, after which the suspected culprit immunosuppressants should be immediately discontinued.
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U2 - 10.1038/s41394-018-0135-y
DO - 10.1038/s41394-018-0135-y
M3 - Article
AN - SCOPUS:85133823417
SN - 2058-6124
VL - 4
JO - Spinal Cord Series and Cases
JF - Spinal Cord Series and Cases
IS - 1
M1 - 100
ER -