Posttransplant
lymphoproliferative disorder (PTLD) is a well-known complication of
renal transplantation with increased incidence after introduction of more powerful immunosuppressive drugs. Presenting symptoms are nonspecific; some patients may be entirely asymptomatic. Herein we have reported a case of PTLD arising in the
lymphocele wall presenting with B-symptoms and deterioration of graft function. A 62-year-old-female with
end-stage renal disease secondary to
Balkan endemic nephropathy and positive Epstein-Barr virus (EBV) serology before
transplantation received a renal transplant from a deceased donor. Six months after
transplantation she was admitted to the hospital with a 1-week history of malaise,
weight loss,
anorexia, night sweats, and febrile episodes. Multisliced computed tomography demonstrated a cystic structure at the renal hilus. Graft function deteriorated, so the patient underwent
puncture of the
lymphocele. Urgent graftectomy was necessary to stop the
bleeding. Pathohistology demonstrated EBV-positive, CD20-positive PTLD. The patient received 6 cycles of
chemotherapy and continued on
hemodialysis. We concluded that a high index of suspicion for PTLD should be maintained when evaluating
lymphoceles arising in the later posttransplantation period. Irrespective of their imaging features, biopsy should be performed to exclude PTLD.