A Rare Presentation of Isolated CNS Posttransplantation Lymphoproliferative Disorder

Posttransplantation lymphoproliferative disorder (PTLD) is a recognized and extremely morbid complication of solid organtransplantation, but central nervous system involvement, particularly in isolation, is rare. There are no standardized treatmentstrategies for PTLD, though commonly used strategies include reduction of immunosuppression, chemotherapy, rituximab,radiation, and surgery. We present a case of an unusual morphologic variant of primary central nervous system PTLD withsuccessful response to rituximab and cranial radiation. A 69-year-old Asian male, who underwent postrenal transplant nineyears earlier, presented with a one-month history of new onset seizure activity. His evaluation revealed multiple brain lesionson magnetic resonance imaging (MRI), as well as serologic and cerebrospinal fluid studies which were positive for Epstein-Barr Virus (EBV) infection. Ultimately, he underwent craniotomy with tissue biopsy with the final pathology report showingposttransplant lymphoproliferative disorder, polymorphic type. The patient was managed with reduction in immunosuppression,rituximab therapy, and cranial radiation treatments. He had demonstrated marked improvement in his neurologic function andwas ultimately discharged to inpatient rehabilitation facility