Yeom Ji Hyun, Kim Won, Kang Kyung Pyo, Kim Hyeongwan, Yu Hee Chul, Hwang Hong Pil, Chung Byeoung Hoon, Jang Kyu Yun, Lee Sik
Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea.
Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea.
Korean J Transplant. 2023 Sep 30;37(3):216-219. doi: 10.4285/kjt.23.0035. Epub 2023 Sep 12.
Posttransplant lymphoproliferative disorders (PTLDs) are severe complications with heterogeneous clinical pictures involving abnormal lymphoproliferation in solid organ transplants and are known to be closely associated with Epstein-Barr virus (EBV) infection. Herein, we present a case of graft lymphoma in a febrile kidney transplant recipient. A 37-year-old woman was admitted with an abrupt 39 °C fever, mild graft discomfort, and gross hematuria. She had received deceased donor kidney transplantation 8 years earlier, but developed graft failure due to a recurrence of immunoglobulin A nephropathy. Laboratory tests revealed anemia and elevated levels of inflammatory markers. Enhanced abdominopelvic computed tomography showed graft swelling with perirenal fat stranding. Thus, we administered antibiotics for a urinary tract infection and increased the doses of steroids due to suspicion of graft intolerance syndrome. However, the patient's symptoms gradually worsened. Eventually, we performed graft nephrectomy and histologically confirmed EBV-positive diffuse large B cell lymphoma. We report a case in which a PTLD was considered in the differential diagnosis of a kidney transplant recipient with symptoms similar to those of a urinary tract infection or graft intolerance syndrome.
移植后淋巴细胞增生性疾病（PTLDs）是严重并发症，临床表现各异，涉及实体器官移植中的异常淋巴细胞增生，且已知与 Epstein-Barr 病毒（EBV）感染密切相关。在此，我们报告一例发热的肾移植受者发生移植肾淋巴瘤的病例。一名 37 岁女性因突然高热 39°C、移植肾轻度不适和肉眼血尿入院。她 8 年前接受了尸体供肾移植，但因免疫球蛋白 A 肾病复发导致移植肾失功。实验室检查显示贫血和炎症标志物水平升高。增强腹部盆腔计算机断层扫描显示移植肾肿胀伴肾周脂肪条索状影。因此，我们给予抗生素治疗尿路感染，并因怀疑移植肾不耐受综合征而增加了类固醇剂量。然而，患者症状逐渐加重。最终，我们进行了移植肾切除术，组织学检查确诊为 EBV 阳性弥漫性大 B 细胞淋巴瘤。我们报告了一例在对有类似尿路感染或移植肾不耐受综合征症状的肾移植受者进行鉴别诊断时考虑到 PTLD 的病例。
