Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
The University of Queensland School of Medicine, Herston, Queensland, Australia.
BMJ Case Rep. 2024 Sep 24;17(9):e260412. doi: 10.1136/bcr-2024-260412.
Kidney transplant recipients are at increased risk of opportunistic infections and malignancy, including space-occupying intracranial lesions. Here, we present a case of a patient presenting with multiple intracranial lesions in the context of a distant history of transplantation. MRI findings were consistent with a large subcortical enhancing lesion. Leading differentials included posttransplant lymphoproliferative disorder and cerebral cryptococcoma. Brain biopsy was undertaken along with PCR testing on tissue detected and Epstein-Barr virus (EBV) DNA. Cerebral toxoplasmosis was diagnosed based on characteristic histology and negative EBV immunohistochemistry. This case demonstrates the difficulties and complexities in reaching a diagnosis in immunocompromised patients and the importance of brain biopsy.
肾移植受者发生机会性感染和恶性肿瘤的风险增加，包括颅内占位性病变。在此，我们报告 1 例在远处移植病史背景下出现多个颅内病变的患者。MRI 结果符合大的皮质下强化病变。主要鉴别诊断包括移植后淋巴组织增生性疾病和脑隐球菌病。进行了脑活检和组织 PCR 检测，检测到 并 EBV DNA。脑弓形虫病的诊断基于特征性组织病理学和 EBV 免疫组织化学阴性。该病例说明了在免疫功能低下患者中做出诊断的困难和复杂性，以及脑活检的重要性。
