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Journal of Transplantation
Volume 2011 (2011), Article ID 865957, 5 pages
http://dx.doi.org/10.1155/2011/865957
Case Report

Lymphomatoid Granulomatosis Treated Successfully with Rituximab in a Renal Transplant Patient

1Department of Nephrology and Renal Transplantation, Caen University Hospital, 14033 Caen, France
2Laboratory of Pathology, Caen University Hospital, 14033 Caen, France
3Department of Clinical Hematology, Caen University Hospital, 14033 Caen, France

Received 7 November 2010; Accepted 8 February 2011

Academic Editor: Bernhard K. Krämer

Copyright © 2011 Cindy Castrale et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lymphomatoid granulomatosis (LYG) in renal transplant recipients is rare multisystemic angiocentric lymphoproliferative disorder with significant malignant potential. Here, we describe LYG in a 70-year-old renal allograft recipient who, 4 years after transplantation, on tacrolimus and mycophenolate mofetil and prednisone maintenance immunosuppression, complained of low-grade fever, persistent headache and gait disturbance. The MRI of the brain revealed diffuse periventricular cerebral and cerebellar contrast-enhanced lesions. The CT scan of the thorax showed multiple pulmonary nodular opacities in both lung fields. The patient was diagnosed LYG based on the cerebral biopsy showing perivascular infiltration of CD20-positive B-lymphocytes with granulomatous lesions and immunofluorescence staining with anti-EBV antibodies. With careful reduction of the immunossuppression combined with the use of rituximab, our patient showed a complete disappearance of LYG, and she is clinically well more than 4 years after the diagnosis, with good kidney function. No recurrence has been observed by radiological imaging until now. This is the first report of a durable (>4 years) complete remission of LYG after treatment with rituximab in renal transplantation.