Post-Transplant Lymphoproliferative Disorder. Lung Lymphoma 20 Years after Renal Transplantation
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Abstract
Post-Transplant Lymphoproliferative Disorder (PTLD) is a rare but potentially life-threatening complication of solid organ transplantation. It occurs in 1% to 3% of kidney transplant recipients and up to 20% of non-kidney allograft recipients. Its onset is usually insidious and asymptomatic in early stages. Diagnosis can be particularly challenging in late-onset forms due to their low frequency and nonspecific clinical presentation.
We present the case of a 55-year-old woman with a history of living-donor renal transplantation performed 21 years earlier, under immunosuppressive therapy. She presented with progressive dyspnea and asthenia. Computed tomography showed pulmonary consolidations in both lower lobes along with bilateral hilar and mediastinal lymphadenopathy. A percutaneous lung biopsy confirmed high-grade B-cell lymphoma with a germinal center phenotype, consistent with a monomorphic form of PTLD. Treatment was initiated by reducing immunosuppression combined with chemotherapy which was well tolerated. This case highlights the importance of considering PTLD in the differential diagnosis of immunosuppressed post-transplant patients with nonspecific symptoms, even if they present late, since this disorder most frequently presents in the first 5 years. The integration of clinical, radiological, and histopathological findings is essential to achieve an accurate diagnosis and to initiate timely and appropriate treatment.
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