An unusual endoscopic ultrasound diagnosis in kidney-transplant patient

Clinical presentation A 29-year-old man who had undergone kidney transplantation in 1999 for chronic glomerular disease, on treatment with ciclosporin, azathioprine and steroids, was admitted for severe, diffuse abdominal pain. No fever or other symptoms were present. Multidetector CT (MDCT) scan showed several chest and abdominal lymphadenopathies and pericardial, pleural and abdominal effusions. A post-transplant lymphoproliferative disorder (PTLD) was suspected and, therefore, azathioprine and ciclosporin were suspended with resolution of serosal effusions. However, cytology and cytofluorimetry from ascites and pleural effusion and surgical histology from supraclavicular lymph node showed no lymphoproliferative disease. Epstein-Barr virus (EBV)-DNA was repeatedly negative, as was serology for HIV. A new MDCT scan confirmed marked reduction of chest and abdominal lymphadenopathies, and resolution of serosal effusion. However, because of persistence of moderate abdominal pain, a (18)F-fluorodeoxyglucose-positron emission tomography-CT scan ((18)F-FDG-PET-CT scans) was performed, and detected multiple areas of accumulation of the radiopharmaceutical in the...
Source: Gut - Category: Gastroenterology Authors: Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research