Hess Gabriel Fridolin, Menter Thomas, Boll Daniel, Steiger Jürg, von Strauss Und Torney Marco
Clarunis, University Center for Gastrointestinal and Liver Disease, St. Clara Hospital and University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland.
Institute of Pathology, University Hospital Basel, Schönbeinstrasse 40, CH-4056 Basel, Switzerland.
J Surg Case Rep. 2020 Apr 7;2020(4):rjaa057. doi: 10.1093/jscr/rjaa057. eCollection 2020 Apr.
This report presents a 74-year-old renal transplant patient suffering of polymorphic-post-transplant-associated lymphoproliferative disease (P-PTLD) within an Eppstein-Barr Virus (EBV) associated mucocutaneous rectal ulcer (MCU). He was initially treated by stapled hemorrhoidopexy for a symptomatic grade III hemorrhoidal prolapse refractory to conservative treatment and rubber band ligations. This leads to severe urge, frequency and stool fragmentation. The symptoms were investigated with a number of interventions until a proctoscopy with biopsies finally revealed the diagnosis. The patient had triple therapy of tacrolimus, mycophenolate mofetil and prednisone initially after transplant several years ago with recent reduction to mycophenolate. The MCU was successfully treated with Retuximab and there was no sign of relaps after 6 months. As EBV-associated PTLD is a well known complication after renal transplant, rectum-MCU seems a rare and only recently described subform of this disease that should be excluded in case of ulcerating lesions in immunosuppressed patients.
本报告介绍了一名74岁的肾移植患者，患有与爱泼斯坦-巴尔病毒（EBV）相关的黏膜皮肤直肠溃疡（MCU）的多形性移植后相关淋巴组织增生性疾病（P-PTLD）。他最初因症状性III度痔脱垂接受吻合器痔上黏膜环切术治疗，该脱垂对保守治疗和橡皮圈套扎术无效。这导致了严重的便意、尿频和大便不成形。通过多种干预措施对症状进行了调查，直到最后通过直肠镜检查及活检才确诊。该患者几年前移植后最初接受了他克莫司、霉酚酸酯和泼尼松三联疗法，最近减为霉酚酸酯单药治疗。MCU通过利妥昔单抗成功治疗，6个月后无复发迹象。由于EBV相关的PTLD是肾移植后一种众所周知的并发症，直肠MCU似乎是这种疾病的一种罕见且最近才被描述的亚型，在免疫抑制患者出现溃疡性病变时应予以排除。
