Late-Onset Post-transplantation Central Nervous System Lymphoproliferative Disorder: Case Report.

Post-transplantation lymphoproliferative disorder (PTLD) is a heterogeneous group of conditions that complicate organ transplantation and are due to immunosuppression. Central nervous system (CNS)-PTLD is rare but its incidence is increasing. It often occurs late and is associated with kidney transplantation and Epstein-Barr virus (EBV) infection. Outcomes are poor. We present the case of a 77-year-old white male who received a cadaveric kidney transplant in 2003. Maintenance immunosuppression consisted of mycofenolate mofetil (MMF), cyclosporine, and prednisolone. In 2017, while admitted for other cause, he presented with de novo epileptic seizures. Because the patient had a pacemaker, magnetic resonance imaging (MRI) could not be performed. The final diagnosis of CNS-PTLD was known through brain biopsy, after a suitable image was obtained with contrasted brain computed tomography (CT). EBV was positive in brain biopsy, cefalospinal fluid, and blood. Treatment was attempted with reduction of immunosuppression. Cyclosporine was switched to sirolimus. The patient died before administration of rituximab. The patient's performance status was poor. There must be awareness for neurological symptoms after kidney transplantation to timely diagnose CNS-PTLD. Contrasted brain CT may be useful to obtain a biopsy specimen in cases where MRI is impossible to use.

Successful Treatment of Strongyloides stercoralis Hyperinfection in a Kidney Transplant Recipient: Case Report.

Strongyloides stercoralis (SS) can cause hyperinfection and disseminated infection in immunosuppressed individuals, with risk of mortality. We report the case of a cadaveric kidney transplant recipient who developed gastrointestinal symptoms and eosinophilia, approximately 3 months after transplantation. Stool examination and esophagogastroduodenoscopy with biopsies were positive for SS larvae. The patient was started on oral ivermectin and immunosuppression was reduced, but still the clinical picture got worse with metabolic ileus and respiratory symptoms, with the need for administration of subcutaneous ivermectin and combined therapy with albendazol. The patient survived and graft function was preserved. The patient was unlikely to be the source of infection. We also present a review of cases of SS infection in kidney transplant recipients.