Korean J Nephrol.  2007 Mar;26(2):294-299.

A Case of Posttransplant Lymphoproliferative Disorder in the Duodenum after Kidney Transplantation

• Kwak JH
• Jin KB
• Kim JE
• Hwang EA
• Han SY
• Park SB
• Kim HC

Abstract

Posttransplant lymphoproliferative disorder (PTLD) is an uncommon but life-threatening complication of immunosuppressive therapy following solid organ transplantation. It encompasses a heterogeneous group of lymphoproliferative disorders ranging from reactive, polyclonal hyperplasia to aggressive non- Hodgkin's lymphoma. The majority of PTLD is of B-cell origin and associated with Epstein-Barr virus (EBV) infection. Gastrointestinal involvement, especially small bowel and colon, is common in patients with PTLD, but the duodenum is rarely involved. We have experienced a case of PTLD involving the duodenum eight years after kidney transplantation in 50-year-old man. Two weeks before admission, he had complained of epigastric pain, and was diagnosed as pangastritis and duodenal ulcer by upper gastrointestinal endoscopy. He was admitted due to aggravated epigastric pain despite anti-ulcer medication. On the seventh hospital day, we found a new mass-like lesion in the pyloric area of antrum and diffuse ulceration in the duodenum by follow-up endoscopy. Histologic findings revealed diffuse large B-cell lymphoma. During reduction in immunosuppressive regimens, his conditions deteriorated rapidly. He died of sepsis associated with duodenal ulcer perforation, 18 days after diagnosis.

Keyword

Lymphoproliferative disorder; Kidney transplantation; Duodenum

MeSH Terms

B-Lymphocytes
Colon
Diagnosis
Duodenal Ulcer
Duodenum*
Endoscopy
Endoscopy, Gastrointestinal
Follow-Up Studies
Herpesvirus 4, Human
Hodgkin Disease
Humans
Hyperplasia
Kidney Transplantation*
Kidney*
Lymphoma, B-Cell
Lymphoproliferative Disorders*
Middle Aged
Organ Transplantation
Sepsis
Transplants
Ulcer