Isolated B cell central nervous system posttransplant lymphoproliferative disorder: Role of magnetic resonance imaging in the diagnosis and management in the absence of neurological signs - a case report

Monisha Jacob; Milly Mathew; Rajeevalochana Parthasarathy; Jayanthi Arulneyam; Siddartha Ghosh; Jose Easow; Sivaranjini Narayanan; Georgi Abraham

doi:10.4103/ijot.ijot_40_20

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CASE REPORT

Year : 2020 \| Volume : 14 \| Issue : 3 \| Page : 243-246

Isolated B cell central nervous system posttransplant lymphoproliferative disorder: Role of magnetic resonance imaging in the diagnosis and management in the absence of neurological signs - a case report Monisha Jacob¹, Milly Mathew², Rajeevalochana Parthasarathy², Jayanthi Arulneyam³, Siddartha Ghosh⁴, Jose Easow⁵, Sivaranjini Narayanan⁶, Georgi Abraham² ¹ Department of Radiology, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India ² Department of Nephrology, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India ³ Department of Neurology, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India ⁴ Department of Neurosurgery, Apollo Hospital, Chennai, Tamil Nadu, India ⁵ Department of Oncology, Apollo Hospital, Chennai, Tamil Nadu, India ⁶ Department of Pathology, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India Correspondence Address: Dr. Georgi Abraham Madras Medical Mission Hospital, 4a, Dr. JJ Nagar, Mogappair, Chennai - 600 037, Tamil Nadu India Source of Support: None, Conflict of Interest: None DOI: 10.4103/ijot.ijot_40_20

A 29-year-old female who received a kidney from her mother 9 months ago, on minimal triple immunosuppression presented with short duration vertigo. There were no focal neurological deficits. Magnetic resonance imaging of the brain revealed peripherally enhancing periventricular lesions, predominantly in the bilateral frontal lobes. Positron-emission tomography showed increased uptake in the brain lesions. A stereotactic biopsy revealed CD20+ monomorphic B cell posttransplant lymphoproliferative disorder. The donor mother and daughter were Epstein–Barr virus (EBV) immunoglobulin G (IgG+)/IgG−. The cerebrospinal fluid and brain biopsy were positive for EBV. Treatment consisted of discontinuing prednisolone and MMF and reducing tacrolimus to 0.5 mg od. Rituximab, zidovudine, ganciclovir, and dexamethasone are being used. She has stable renal function.



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