B LIM 1, P TAN 2, H KULKARNI 1
1Renal Unit, Royal Perth Hospital, Perth, Australia, 2Haematology Dept, Royal Perth Hospital, Perth, Australia
Background: We report a case of Burkitt Lymphoma, 6 years post-renal transplant in a patient with FGN as a native renal disorder. FGN is associated with underlying malignancies including leukaemia and multiple myeloma (4-23%). Immunotactoid Glomerulonephritis (IGN) in contrast, is more frequently associated with B-Cell Lymphomas, including Burkitt Lymphoma. However, the association of PTLD Burkitt Lymphoma in a renal transplant patient with prior native kidneys FGN has never been reported.
Case Presentation:42 year-old male diagnosed with FGN in 2005, underwent pre-emptive, unrelated live renal transplant in 2015 (HLA 6/6 mismatch; Induction: anti-thymocyte globulin). Patient maintained stable allograft function in the post-transplant course (on triple immunosuppression : steroid, mycofenolate mofetil, tacrolimus; stable creatinine 80’s-90’s umol/L). 6 years post-transplant, he presented with acute ascites with 1 month history of constitutional symptoms. Large peritoneal deposits on CT abdomen/pelvis was confirmed as widespread, monomorphic, high grade B-cell Burkitt lymphoma (CD 10+,BCL2-ve,C-MYC+, TdT-ve,cyclinD1-ve,TCL1+) via omental mass core biopsy and PET scan. Lumbar puncture cytopathology was negative for malignant cells. EBV viral load remained undetected on quantitative PCR. Large tumour volume was reflected by pre-treatment tumour lysis syndrome, exacerbated by 4 chemotherapy C4-DA-R-EPOCH sessions, with lactate dehydrogenase (LDH) peaking to 60,000 U/L. Patient soon developed encephalopathy and acute renal failure, requiring intensive care for CVVHD and rasburicase. He was discharged with 6 total (C4-DA-R-EPOCH) chemotherapy cycles for completion, and maintains stable allograft function to date. Repeat PET scan after 4 chemotherapy cycles demonstrated complete metabolic response to therapy at the previous sites of disease.
Conclusion: Late onset Burkitt Lymphoma post-renal transplant in a case with primary renal diagnosis of FGN may result in good prognosis, if treated early and aggressively.
Dr. Brenda Lim is a post-graduate resident year 2 who graduated from the University of Adelaide, South Australia in 2019. After graduating, she started her internship at Royal Perth Hospital in Western Australia. She worked as a resident in the Royal Perth Hospital Nephrology and Dialysis Unit in 2021 under the guidance of Dr. Hemant Kulkarni and other nephrology consultants. Brenda holds special interest in nephrology due to the intricacy of nephrology physiology and its established co-dependent interactions with other organs.