Post‑transplant lymphoproliferative disorder presenting with skin ulceration in a renal transplant recipient who achieved sustained remission with rituximab therapy: A case report

Law,Man Fai; Chan,Hay Nun; Lai,Ho Kei; Ha,Chung Yin; Ng,Celia; Yeung,Yiu Ming; Yip,Sze Fai

doi:10.3892/mco.2016.1024

Post‑transplant lymphoproliferative disorder presenting with skin ulceration in a renal transplant recipient who achieved sustained remission with rituximab therapy: A case report

Authors:
- Man Fai Law
- Hay Nun Chan
- Ho Kei Lai
- Chung Yin Ha
- Celia Ng
- Yiu Ming Yeung
- Sze Fai Yip
View Affiliations

Affiliations: Department of Medicine, Tuen Mun Hospital, Hong Kong SAR 999077, P.R. China
Published online on: September 19, 2016 https://doi.org/10.3892/mco.2016.1024
Pages: 610-612

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Post-transplant lymphoproliferative disorder (PTLD) is associated with a variety of clinical presentations, but rarely involves the skin. We herein report a case of PTLD presenting with skin ulceration in a renal transplant recipient. A biopsy of the ulcer confirmed the diagnosis of diffuse large B‑cell lymphoma. The patient was initially treated with immunosuppression reduction, but the skin ulcer persisted. He was then treated with two courses of chemotherapy, but his condition was complicated with cryptococcal infection. Antifungal agents were administered to control the fungal infection. The patient later developed lymphoma recurrence and was successfully treated with single‑agent rituximab. The patient remains well 6 years after treatment, with no evidence of disease relapse. Therefore, PTLD may manifest as skin lesions and physicians must be aware of this rare presentation.

View Figures

View References

1	Landgren O, Gilbert ES, Rizzo JD, Socié G, Banks PM, Sobocinski KA, Horowitz MM, Jaffe ES, Kingma DW, Travis LB, et al: Risk factors for lymphoprolipherative disorders after allogeneic hematolopoietic cell transplantation. Blood. 113:4992–5001. 2009. View Article : Google Scholar : PubMed/NCBI
2	Seçkin D, Barete S, Euvrard S, Francès C, Kanitakis J, Geusau A, Del Marmol V, Harwood CA, Proby CM, Ali I, et al: Primary cutaneous posttransplant lymphoproliferative disorders in solid organ transplant recipients: A multicenter European case series. Am J Transplant. 13:2146–2153. 2013. View Article : Google Scholar : PubMed/NCBI
3	Tanner JE and Alfieri C: The Epstein-Barr virus and post-transplant lymphoproliferative diseases: Interplay of immunosuppression, EBV, and the immune system in disease pathogenesis. Transpl Infect Dis. 3:60–69. 2001. View Article : Google Scholar : PubMed/NCBI
4	Swerdlow SH, Webber SA, Chadburn A and Ferry JA: Post-transplant lymphoproliferative disordersWHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Swerdlow SH, Campo E, Harris NL, Jafffe ES, Pileri SA, Stein H, Thiele J and Vardiman JW: 4th. International Agency for Research on Cancer; Lyon: pp. 343–349. 2008
5	Trofe J, Beebe TM, Buell JF, Hanaway MJ, First MR, Alloway RR, Gross TG and Woodle ES: Posttransplant malignancy. Prog Transplant. 14:193–200. 2004. View Article : Google Scholar : PubMed/NCBI
6	Nassi L and Gaidano G: II. Challenges in the management of post-transplant lymphoproliferative disorder. Hematol Oncol. 33(Suppl 1): S96–S99. 2015. View Article : Google Scholar
7	Dierickx D, Tousseyn T and Gheysens O: How I treat posttransplant lymphoproliferative disorders. Blood. 126:2274–2283. 2015. View Article : Google Scholar : PubMed/NCBI
8	Dierickx D, Tousseyn T, Sagaert X, Fieuws S, Wlodarska I, Morscio J, Brepoels L, Kuypers D, Vanhaecke J, Nevens F, et al: Single-center analysis of biopsy-confirmed posttransplant lymphoproliferative disorder: Incidence, clinicopathological characteristics and prognostic factors. Leuk Lymphoma. 54:2433–2440. 2013. View Article : Google Scholar : PubMed/NCBI
9	Choquet S, Trappe R, Leblond V, Jäger U, Davi F and Oertel S: CHOP-21 for the treatment of post-transplant lymphoproliferative disorders (PTLD) following solid organ transplantation. Haematologica. 92:273–274. 2007. View Article : Google Scholar : PubMed/NCBI
10	Choquet S, Leblond V, Herbrecht R, Socié G, Stoppa AM, Vandenberghe P, Fischer A, Morschhauser F, Salles G, Feremans W, et al: Efficacy and safety of rituximab in B-cell post-transplantation lymphoproliferative disorders: Results of a prospective multicenter phase 2 study. Blood. 107:3053–3057. 2006. View Article : Google Scholar : PubMed/NCBI
11	Oertel SH, Verschuuren E, Reinke P, Zeidler K, Papp-Váry M, Babel N, Trappe RU, Jonas S, Hummel M, Anagnostopoulos I, et al: Effect of anti-CD 20 antibody rituximab in patients with post-transplant lymphoproliferative disorder (PTLD). Am J Transplant. 5:2901–2906. 2005. View Article : Google Scholar : PubMed/NCBI
12	Trappe R, Oertel S, Leblond V, Mollee P, Sender M, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Salles G, et al: Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): The prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 13:196–206. 2012. View Article : Google Scholar : PubMed/NCBI
13	Au WY, Pang A, Choy C, Chim CS and Kwong YL: Quantification of circulating Epstein-Barr virus (EBV) DNA in the diagnosis and monitoring of natural killer cell and EBV-positive lymphomas in immunocompetent patients. Blood. 104:243–249. 2004. View Article : Google Scholar : PubMed/NCBI
14	Gulley ML and Tang W: Using Epstein-Barr viral load assays to diagnose, monitor, and prevent posttransplant lymphoproliferative disorder. Clin Microbiol Rev. 23:350–366. 2010. View Article : Google Scholar : PubMed/NCBI
15	Law MF, Poon WL, Ng KS, Chan HN, Lai HK, Ha CY, Ng C, Yeung YM and Yip SF: Quantification of plasma Epstein-Barr virus DNA for assessing treatment response in a patient with plasmablastic lymphoma. Ann Hematol. 91:789–791. 2012. View Article : Google Scholar : PubMed/NCBI