Plasmacytoma-Like Post-Transplantation Lymphoproliferative Disorder Confined to the Renal Allograft: A Case Report

A 44-year-old woman who had end-stage kidney disease from diabetes and hypertension underwent a deceased donor kidney transplantation. Eighteen months after the transplantation she developed an abrupt increase in her creatinine level and a kidney biopsy specimen showed the presence of a plasma cell–rich infiltrate. A vast majority of the plasma cells were kappa (κ) light chain restricted on in situ hybridization. κ and lambda (λ) free light chain were elevated in her serum and so was the κ/λ ratio. A bone marrow biopsy specimen showed no evidence of clonal plasmacytosis. A positron emission tomography (PET) scan showed hypermetabolic activity confined to the kidney. Prior to transplantation she was Epstein-Barr virus (EBV) immunoglobulin (Ig)G-negative but had detectable EBV based on polymerase chain reaction (PCR) in her blood during this episode. Despite reduction in immunosuppression there was no change in the κ/λ ratio and her renal function worsened. She underwent a transplant nephrectomy and her κ/λ ratio became normal. Twenty-one months later she is lymphoma-free and doing well on dialysis. Plasmacytoma-like post-transplantation lymphoproliferative disorder (PTLD) is rare and even more is the localization of the malignancy to the allograft. When reduction of immunosuppression is unsuccessful in treatment, removal of the organ may be necessary as is demonstrated in our case.