Primary brain T-cell lymphoma after kidney transplantation: a case report

Background: Development of primary brain PTLD after kidney transplantation is uncommon, and the incidence of T-cell phenotypes is much more rarely reported in the previous literature. However, prognosis of T-cell PTLD is typically grave, so early diagnosis and treatment are crucial to patient survival. Case Description: A 60-year-old woman, who had received a kidney transplant 4 years previously, presented with focal seizures and left hemiparesis. She underwent serial diagnostic neuroimaging, which revealed an undefined etiology of an intracerebral tumor. Pathologic biopsy was mandatory. The tumor was grossly removed and its pathology was determined to be monomorphic T-cell lymphoma. No other organ involvement was noted. The patient underwent chemotherapy with a combination of carmustine, oncovin, and methylprednisolone. The patient's neurologic signs, however, deteriorated rapidly, and the patient finally died of neutropenia and septic shock 1 month after chemotherapy. Conclusions: Development of primary brain T-cell PTLD after kidney transplantation is rare and typically has a grave prognosis, emphasizing the importance of early diagnosis and treatment. This case illustrates that the diagnosis of lymphoma can only be confirmed by pathologic biopsy; however, magnetic resonance imaging, in particular magnetic resonance spectroscopy, is a powerful tool for differential diagnosis.