Shirai Kana, Ogata Masatomo, Murata-Hasegawa Marie, Miyauchi Masataka, Sakurai Yuko, Shinoda Kazunobu, Koike Junki, Shibagaki Yugo, Yazawa Masahiko
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
Department of Pharmacy, St Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan.
CEN Case Rep. 2025 Feb 19. doi: 10.1007/s13730-025-00976-5.
Post-transplant lymphoproliferative disorder (PTLD) is a severe complication of solid organ transplantation, and its manifestation as peritoneal lymphomatosis (PL) is extremely rare. This report describes the case of a 65-year-old kidney transplant recipient who presented with massive ascites as the initial symptom of PTLD 8 years post-transplantation. The patient experienced a sudden onset of ascites, and both his serum and ascitic fluid showed elevated lactate dehydrogenase (LDH) levels along with characteristic computed tomography (CT) findings, both of which raised the suspicion of lymphoma. The cytology of the ascitic fluid confirmed the diagnosis of peritoneal primary diffuse large B-cell lymphoma, leading to an early diagnosis of PL and management strategies. Although the patient developed tumor lysis syndrome soon after chemotherapy, prompt management led to complete remission. When ascites is observed in post-transplant recipients, it is essential to consider PTLD, recognize the diagnostic value of LDH levels and CT imaging, and emphasize the importance of early intervention to achieve favorable outcomes. To the best of our knowledge, this is the first reported case of PL in a kidney transplant recipient.
移植后淋巴细胞增生性疾病（PTLD）是实体器官移植的一种严重并发症，其表现为腹膜淋巴瘤（PL）极为罕见。本报告描述了一例65岁的肾移植受者，该患者在移植后8年出现大量腹水，这是PTLD的首发症状。患者腹水突然发作，其血清和腹水乳酸脱氢酶（LDH）水平均升高，同时伴有特征性的计算机断层扫描（CT）表现，这两者均引发了对淋巴瘤的怀疑。腹水细胞学检查确诊为腹膜原发性弥漫性大B细胞淋巴瘤，从而实现了PL的早期诊断及管理策略。尽管患者在化疗后不久出现了肿瘤溶解综合征，但及时的处理使其完全缓解。当在移植后受者中观察到腹水时，必须考虑PTLD，认识到LDH水平和CT成像的诊断价值，并强调早期干预以取得良好结局的重要性。据我们所知，这是首例报道的肾移植受者发生PL的病例。
