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eISSN 3022-7712

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Korean J Transplant 2023; 37(3): 216-219

Published online September 30, 2023

https://doi.org/10.4285/kjt.23.0035

© The Korean Society for Transplantation

Graft lymphoma in a kidney transplant recipient: a case report

Ji Hyun Yeom1,2 , Won Kim1,2,3 , Kyung Pyo Kang1,2,3 , Hyeongwan Kim1,2 , Hee Chul Yu2,3,4 , Hong Pil Hwang2,3,4 , Byeoung Hoon Chung2,3,4 , Kyu Yun Jang2,5 , Sik Lee1,2,3

1Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
2Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
3Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
4Department of Surgery, Jeonbuk National University Hospital, Jeonju, Korea
5Department of Pathology, Jeonbuk National University Medical School, Jeonju, Korea

Correspondence to: Sik Lee
Department of Internal Medicine, Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea
E-mail: mercifuldoc@gmail.com

Received: June 23, 2023; Revised: July 30, 2023; Accepted: August 4, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Kidney transplantation, Lymphoproliferative disorders, Epstein-Barr virus, Case reports

HIGHLIGHTS
  • We present a case of confirmed lymphoma after nephrectomy in a kidney transplant (KT) recipient with allograft dysfunction showing symptoms similar to those of urinary tract infection (UTI).

  • A KT recipient had a persistent fever that did not respond to antibiotics.

  • We considered graft intolerance syndrome and performed nephrectomy; however, we eventually confirmed graft lymphoma.

  • This case emphasizes the need to consider posttransplant lymphoproliferative disorders in the differential diagnosis of KT recipients with symptoms suggestive of a UTI or graft intolerance syndrome.