Case report: successful treatment of posttransplant lymphoproliferative disorder and quiescence of dermatomyositis with rituximab and sirolimus.

Abstract

Posttransplant lymphoproliferative disorder (PTLD) remains one of the most important complications of intensive immunosuppressive therapy. A 65-year-old Caucasian woman received a primary en bloc kidney transplant from a deceased 2-year-old donor. After antithymocyte globulin induction she was treated with a maintenance regimen including cyclosporine and mycophenylate mofetil (MMF). She had a history of recurrent dermatomyositis, suggesting a flawed immune system. After a benign course for 9 months and after an increase in MMF from 2 to 3 g daily, she presented with pneumonia owing to Candida albicans, which was responsive to antibiotics, as was the PTLD. Persistent fever led to a diagnosis of PTLD. The immunosuppressive regimen was converted to sirolimus (SRL) and rituximab, with over 90% necrosis of the neoplasm at 1 month. However, owing to concern at exploration, the allografts were extirpated. This case documented the benefit of the rituximab-SRL combination to treat PTLD while maintaining dermatomyositis in remission.

• Authors: Z Kaposztas, W B Etheridge, B D Kahan
• Journal: Transplantation proceedings (Transplant Proc) Vol. 40 Issue 5 Pg. 1744-6 (Jun 2008) ISSN: 0041-1345 [Print] United States
• PMID: 18589184 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Immunosuppressive Agents
• Rituximab
• Sirolimus

Topics

• Aged
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Murine-Derived
• Appendectomy
• Child, Preschool
• Dermatomyositis (drug therapy, surgery)
• Female
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Kidney Function Tests
• Kidney Transplantation (adverse effects, immunology, physiology)
• Lymphoproliferative Disorders (drug therapy)
• Ovariectomy
• Postoperative Complications (drug therapy)
• Rituximab
• Sirolimus (therapeutic use)