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EBV‐Associated Leukoencephalopathy with Late Onset of Central Nervous System Lymphoma in a Kidney Transplant Recipient
Author(s) -
Vaglio A.,
Manenti L.,
Mancini C.,
Chierici E.,
Cobelli R.,
Bacci F.,
Palmisano A.,
Buzio C.,
Bignardi L.,
Maggiore U.
Publication year - 2010
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2009.02999.x
Subject(s) - medicine , leukoencephalopathy , progressive multifocal leukoencephalopathy , lymphoma , pathology , encephalopathy , primary central nervous system lymphoma , transplantation , hyperintensity , central nervous system , magnetic resonance imaging , immunology , virus , radiology , disease
Central nervous system (CNS) lymphoma is a rare posttransplant lymphoproliferative disorder (PTLD), which usually has a poor outcome. To date, no specific conditions predisposing to this complication have been identified. We here describe the case of a renal transplant patient who was initially diagnosed as having Epstein‐Barr virus (EBV)‐associated leukoencephalopathy and ultimately developed EBV‐positive CNS lymphoma. The patient was a young lady who, 2 years after transplantation, presented with focal neurological and electroencephalographic abnormalities and diffuse white matter lesions on brain magnetic resonance imaging. EBV‐DNA was detected in the cerebrospinal fluid (CSF) by polymerase chain reaction. After acyclovir therapy and immunosuppressive drug tapering, the symptoms and electroencephalographic abnormalities subsided, and EBV‐DNA disappeared from the CSF. Ten years later, a bulky cerebral mass was found. After excision, a diagnosis of EBV‐positive, Hodgkin‐like monomorphic B‐cell PTLD was made. This case illustrates the potential pathophysiological relationships between EBV infection, leukoencephalopathy and CNS lymphoma; although a long time elapsed from the initial neurological illness to CNS lymphoma, a link between these two conditions cannot be excluded. Therefore, a careful long‐term follow‐up of EBV‐related encephalopathy is advisable.