Lookup NU author(s): Emily Glover,
Dr Ally Speight,
Dr Despina Televantou,
Dr Stephanie Needham,
Professor Neil Sheerin
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
BackgroundPost-transplant lymphoproliferative disease is a recognized complication following solid organ transplantation. This is usually a B cell disease and frequently associated with Epstein Barr virus infection, although T cell PTLD can occur. T cell PTLD is usually a monomorphic, lymphomatous disease associated with an adverse prognosis. Case reportWe report a 52 year old male pre-emptive renal transplant recipient who developed severe diarrhea with weight loss following intensification of his immunosuppression due to antibody mediated rejection 3 years after transplantation. Duodenal biopsy demonstrated monoclonal CD8+ T cell duodenitis leading to increased intraepithlieal lymphocytes and sub-total villous atrophy mimicking coeliac disease. Coeliac disease was excluded by negative anti-tissue transglutaminase antibody, HLA-DQ2 and HLA-DQ8 testing.There was no evidence of lymphoma either on biopsy or CT enterography and no FDG avid disease on PET.Symptoms did not improve with reduction of immunosuppression, but resolved fully on complete withdrawal of treatment. The transplant failed and he was established on dialysis. The diagnosis was early PTLD.ConclusionsOesophagogastroduodenoscopy with small bowel biopsies is a useful investigation for determining the cause of diarrhoea in renal transplant patients when more common causes have been excluded.This is the first report that we are aware of clonal T cell PTLD mimicking coeliac disease which only resolved after complete withdrawal of immunosuppression. As treatments for lymphoma are aggressive they are only initiated in the malignant phase and management of early stage PTLD is to minimise risk of progression by reducing immunosuppression. Any plans to retransplant will have to take into consideration the possibility that PTLD will recur.
Author(s): Glover EK, Speight A, Televantou D, Needham S, Sheerin NS
Publication type: Article
Publication status: Published
Journal: BMC Nephrology
Online publication date: 10/06/2020
Acceptance date: 04/06/2020
Date deposited: 07/06/2020
ISSN (electronic): 1471-2369
Publisher: BioMed Central Ltd.
Altmetrics provided by Altmetric