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Case Reports
. 2009 Nov-Dec;16(6):195-7.
doi: 10.1155/2009/521548.

Multiple cavitating nodules in a renal transplant recipient

Sharla-Rae J Olsen  1 , Mohit Bhutani
Affiliations
Case Reports

Multiple cavitating nodules in a renal transplant recipient

Sharla-Rae J Olsen et al. Can Respir J. 2009 Nov-Dec.

Abstract
in English, French

Pulmonary nodules are common following solid organ transplantation and vary in etiology. Nodules with central cavitation are most likely to be of infectious origin in the post-transplant population. A novel presentation of post-transplant lymphoproliferative disorder manifesting as multiple cavitating pulmonary nodules is described. The patient, a 45-year-old female renal transplant recipient, presented with constitutional symptoms and a chest x-ray showing multiple bilateral cavitating lesions. A computed tomography scan confirmed innumerable, randomly dispersed, cavitating nodules in the lung parenchyma. Multiple large hypodense lesions were identified in the liver and spleen. The appearance of the native and transplanted kidneys was normal. A liver biopsy identified an Epstein- Barr virus-negative, diffuse, large B cell lymphoma. Repeat imaging after treatment with a cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone/prednisolone regimen demonstrated dramatic resolution of all lesions. The present case represents a unique radiographic presentation of post-transplant lymphoproliferative disorder not previously reported in the literature.

Les nodules pulmonaires sont courants après la greffe d’un organe solide, et leur étiologie varie. Les nodules dotés d’une cavité centrale sont plus susceptibles d’être d’origine infectieuse chez la population greffée. On décrit un cas de nouvelle présentation d’un trouble lymphoprolifératif après une greffe, se manifestant par de multiples nodules pulmonaires cavitaires. La patiente, une femme de 45 ans greffée du rein, a consulté en raison de symptômes constitutionnels et d’une radiographie pulmonaire révélant de multiples lésions cavitaires bilatérales. Une tomodensitométrie a confirmé la présence d’innombrables nodules cavitaires répartis aléatoirement dans le parenchyme pulmonaire. On a dépisté de grosses lésions hypodenses multiples dans le foie et la rate. L’apparence du rein indigène et du rein greffé était normale. Une biopsie rénale a permis de repérer un important lymphome à grosses cellules B diffus, négatif au virus d’Epstein-Barr. La reprise de l’imagerie, après le traitement à la cyclophosphamide, à l’hydroxydaunorubicine, à l’oncovine et à la prednisone et prednisolone, a révélé une résolution remarquable de toutes les lésions. Le présent cas constitue une présentation radiographique unique de trouble lymphoprolifératif après une greffe, jamais publiée auparavant.

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Figures

Figure 1)
Figure 1)
Chest x-ray at presentation showing multiple bilateral pulmonary nodules, many with central necrosis
Figure 2)
Figure 2)
A Computed tomography scan of the chest showing numerous cavitating pulmonary nodules dispersed randomly throughout both lung fields. B Computed tomography scan of the upper abdomen showing multiple hypodensities in the liver and spleen
Figure 3)
Figure 3)
Chest x-ray after chemotherapy showing resolution of disease
Figure 4)
Figure 4)
A Computed tomography scan of the chest showing clearing of all nodules at three months following chemotherapy. B Views of the upper abdomen also show dramatic resolution of the liver and splenic lesions
See this image and copyright information in PMC

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References

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