An unusual presentation of Burkitt's lymphoma in a renal allograft recipient

Abstract

Posttransplant lymphoproliferative disorders (PTLDs) are rare complication encountered in solid organ transplantation. They can be fatal and often occur within 1 year of transplantation. Often, they are associated with Epstein–Barr virus (EBV) reactivation occurring in a setting of immunosuppression. Among PTLDs, Burkitt's lymphoma is uncommon. In this report, we present a renal allograft recipient who presented with late-onset PTLD like Burkitt's lymphoma, 12 years after renal transplantation, and was negative for EBV markers. The clinical presentation of PTLD is often subtle as it usually involves the extranodal sites. The gastrointestinal system is one of the frequent sites involved by PTLD. The diagnosis is confirmed by histopathological analysis including immunohistochemistry (IHC) of the suspected lesion. Analysis for the EBV status of the tumor is of major significance in predicting prognosis. Late-onset PTLD is usually monomorphic and the prognosis is poor if the EBV status is negative. Reduction or even withdrawal of immunosuppression is the pivotal step in the treatment of PTLD along with the use of chemotherapeutic agents and rituximab.