Late Onset Graft Plasmacytoma-Like PTLD Presenting as Acute Hyperglycemia in a Kidney-Pancreas Transplant Recipient
Allograft infiltration has been described in up to 20% of all patients with posttransplant lymphoproliferative disorder (PTLD), most representing EBV-positive B-cell lymphomas. Plasma cells are often observed in humoral rejection biopsies, but graft infiltration by plasmacytoma-like PTLD is rare. We...
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| Format: | Article |
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Wiley
2019-01-01
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| Series: | Case Reports in Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2019/2818074 |
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| author | P. Ventura-Aguiar M. T. Cibeira A. Martinez M. Cuatrecasas M. Aymerich J. Ferrer J. Blade F. Diekmann M. J. Ricart |
| author_facet | P. Ventura-Aguiar M. T. Cibeira A. Martinez M. Cuatrecasas M. Aymerich J. Ferrer J. Blade F. Diekmann M. J. Ricart |
| author_sort | P. Ventura-Aguiar |
| collection | DOAJ |
| description | Allograft infiltration has been described in up to 20% of all patients with posttransplant lymphoproliferative disorder (PTLD), most representing EBV-positive B-cell lymphomas. Plasma cells are often observed in humoral rejection biopsies, but graft infiltration by plasmacytoma-like PTLD is rare. We report the case of a 54-year-old simultaneous pancreas-kidney transplant recipient (immunosuppression: OKT3, methylprednisolone, cyclosporine, and azathioprine), diagnosed with an IgG-kappa monoclonal gammopathy of undetermined significance eighteen years after transplant. Nine months later, pancreas allograft biopsy performed due to new-onset hyperglycemia (HgA1C 8.6%, C-peptide 6.15ng/mL and anti-GAD 0.9UI/mL) revealed a monotypic plasma cell infiltrate, CD19, CD79a, CD138 positive, with IgG-kappa light chain restriction, and EBV negative. PET-scan FDG uptake was limited to pancreas allograft. Tumor origin could not be established (using DNA microsatellite analysis). Despite treatment with bortezomib and dexamethasone, patient eventually died one month later. This is the first report of a late onset extramedullary plasmacytoma involving a pancreas allograft. |
| format | Article |
| id | doaj-art-6f0b3f0e702346668adf81560b50f957 |
| institution | Kabale University |
| issn | 2090-6641 2090-665X |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Nephrology |
| spelling | doaj-art-6f0b3f0e702346668adf81560b50f9572025-02-03T01:26:33ZengWileyCase Reports in Nephrology2090-66412090-665X2019-01-01201910.1155/2019/28180742818074Late Onset Graft Plasmacytoma-Like PTLD Presenting as Acute Hyperglycemia in a Kidney-Pancreas Transplant RecipientP. Ventura-Aguiar0M. T. Cibeira1A. Martinez2M. Cuatrecasas3M. Aymerich4J. Ferrer5J. Blade6F. Diekmann7M. J. Ricart8Department of Nephrology and Renal Transplant, Hospital Clínic, Barcelona, SpainDepartment of Hematology, Hospital Clínic, Barcelona, SpainDepartment of Pathology, Hospital Clínic, Barcelona, SpainDepartment of Pathology, Hospital Clínic, Barcelona, SpainDepartment of Hematology, Hospital Clínic, Barcelona, SpainDepartment of Hepatobiliopancreatic Surgery, Hospital Clínic, Barcelona, SpainDepartment of Hematology, Hospital Clínic, Barcelona, SpainDepartment of Nephrology and Renal Transplant, Hospital Clínic, Barcelona, SpainDepartment of Nephrology and Renal Transplant, Hospital Clínic, Barcelona, SpainAllograft infiltration has been described in up to 20% of all patients with posttransplant lymphoproliferative disorder (PTLD), most representing EBV-positive B-cell lymphomas. Plasma cells are often observed in humoral rejection biopsies, but graft infiltration by plasmacytoma-like PTLD is rare. We report the case of a 54-year-old simultaneous pancreas-kidney transplant recipient (immunosuppression: OKT3, methylprednisolone, cyclosporine, and azathioprine), diagnosed with an IgG-kappa monoclonal gammopathy of undetermined significance eighteen years after transplant. Nine months later, pancreas allograft biopsy performed due to new-onset hyperglycemia (HgA1C 8.6%, C-peptide 6.15ng/mL and anti-GAD 0.9UI/mL) revealed a monotypic plasma cell infiltrate, CD19, CD79a, CD138 positive, with IgG-kappa light chain restriction, and EBV negative. PET-scan FDG uptake was limited to pancreas allograft. Tumor origin could not be established (using DNA microsatellite analysis). Despite treatment with bortezomib and dexamethasone, patient eventually died one month later. This is the first report of a late onset extramedullary plasmacytoma involving a pancreas allograft.http://dx.doi.org/10.1155/2019/2818074 |
| spellingShingle | P. Ventura-Aguiar M. T. Cibeira A. Martinez M. Cuatrecasas M. Aymerich J. Ferrer J. Blade F. Diekmann M. J. Ricart Late Onset Graft Plasmacytoma-Like PTLD Presenting as Acute Hyperglycemia in a Kidney-Pancreas Transplant Recipient Case Reports in Nephrology |
| title | Late Onset Graft Plasmacytoma-Like PTLD Presenting as Acute Hyperglycemia in a Kidney-Pancreas Transplant Recipient |
| title_full | Late Onset Graft Plasmacytoma-Like PTLD Presenting as Acute Hyperglycemia in a Kidney-Pancreas Transplant Recipient |
| title_fullStr | Late Onset Graft Plasmacytoma-Like PTLD Presenting as Acute Hyperglycemia in a Kidney-Pancreas Transplant Recipient |
| title_full_unstemmed | Late Onset Graft Plasmacytoma-Like PTLD Presenting as Acute Hyperglycemia in a Kidney-Pancreas Transplant Recipient |
| title_short | Late Onset Graft Plasmacytoma-Like PTLD Presenting as Acute Hyperglycemia in a Kidney-Pancreas Transplant Recipient |
| title_sort | late onset graft plasmacytoma like ptld presenting as acute hyperglycemia in a kidney pancreas transplant recipient |
| url | http://dx.doi.org/10.1155/2019/2818074 |
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