Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Primary effusion lymphoma (PEL) in a renal transplant patient

Raghda Noureldin, Syed Athar, Vidya Nagrale and Waqar Gaba
Download PDF
DOI: https://doi.org/10.7861/clinmed.20-2-s53
Clin Med March 2020
Raghda Noureldin
ASheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Syed Athar
ASheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Vidya Nagrale
ASheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Waqar Gaba
ASheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
Loading

Introduction

Primary effusion lymphoma (PEL) is a lymphoma of large B cells that primarily presents as effusions without a tumour mass.1,2 PEL occurs in immunodeficient states such as acquired immunodeficiency syndrome (AIDS) or with use of immunosuppressant medications, and is associated with human herpesvirus-8 (HHV-8) and Epstein–Barr virus (EBV).2,3 We report a case of primary effusion lymphoma 15 years after renal transplant, presenting as exudative ascites.

Case presentation

An 81-year-old African woman presented with a history of weight loss and abdominal distention of 2 weeks’ duration. The patient underwent renal transplantation 15 years ago; the aetiology of her renal failure was hypertension on immunosuppressant agents including mycophenolate mofetil and cyclosporine. She also has a history of heart failure with preserved ejection fraction, persistent atrial fibrillation on apixaban, hypertension, dyslipidaemia and severe pulmonary arterial hypertension. The patient had been treated with right-sided thoracentesis for pleural effusion 2 years prior to presentation; cytology was suggestive of high-grade lymphoproliferative disease. She was lost to follow-up for further workup since then. Physical examination was positive for ascites, with no palpable masses, lymph nodes or other significant findings. Lab tests showed normocytic normochromic anaemia, mild neutropenia and hyperosmolar hyponatraemia; polymerase chain reaction test was negative for HIV, cytomegalovirus (CMV) and EBV. Computed tomography (CT) of her neck/chest/abdomen and pelvis were consistent with ascites in all abdominal quadrants; no solid masses were reported. Ascitic fluid was exudative on analysis, with peritoneal protein of 68 g/L and lactate dehydrogenase of 2,559 IU/L. Bacterial and tuberculosis cultures of ascitic fluid were negative. On cytology, lymphoma cells were found to be positive for multiple immunohistochemical stains including CD38, CD30, epithelial membrane antigen (EMA) and HHV-8, but negative for CD138, CD20 and PAX-5. An EBV-encoded small ribonucleic acid (EBER) chromogenic in situ hybridisation study was negative. Concurrent flow cytometry showed an abnormal B-lymphoma population positive for CD45 and CD38, and negative for B, T and myeloid markers. Fig 1 shows a cytospin of the paracentesis fluid, showing a large, pleomorphic lymphoma cell with basophilic cytoplasm. Based on the above histopathological and flow cytometry findings, PEL was diagnosed. A plan of management was discussed in the presence of the patient’s family, haematology and internal medicine teams; the family was aware of the nature of the disease, and the poor prognosis associated with it. Active versus palliative care was discussed with risks and benefit of treatment explained. The patient opted for palliative management as per family preference, with no further investigations or treatment to be pursued.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Cytospin of the paracentesis fluid (Giemsa stain; original magnification x 100; oil immersion).

Conclusion

This case is a rare presentation of PEL presenting as exudative ascites in the setting of immunosuppression in an organ transplant recipient from the development of an HHV-8 infection. This highlights the importance of considering PEL as a possible diagnosis in HIV-seronegative older patients receiving long-term immunosuppressant medications.

Conflicts of interest

None declared.

  • © Royal College of Physicians 2020. All rights reserved.

References

  1. ↵
    1. Broaddus VC
    , Mason RJ, Ernst JD, et al. (eds). Murray and Nadel’s Textbook of Respiratory Medicine, 6th edn. Philadelphia: Elsevier Saunders, 2016.
  2. ↵
    1. Sultana S
    , Al Salihi S, Tandon N, et al. Post-transplant lymphoproliferative disorder presented in a form of primary effusion lymphoma with t (8; 14). Ann Clin Lab Sci 2017;47:344–8.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Kugasia IAR
    , Kumar A, Khatri A, et al. Primary effusion lymphoma of the pleural space: report of a rare complication of cardiac transplant with review of the literature. Transpl Infect Dis 2019;21:e13005.
    OpenUrl
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Primary effusion lymphoma (PEL) in a renal transplant patient
Raghda Noureldin, Syed Athar, Vidya Nagrale, Waqar Gaba
Clinical Medicine Mar 2020, 20 (Suppl 2) s53-s54; DOI: 10.7861/clinmed.20-2-s53

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Primary effusion lymphoma (PEL) in a renal transplant patient
Raghda Noureldin, Syed Athar, Vidya Nagrale, Waqar Gaba
Clinical Medicine Mar 2020, 20 (Suppl 2) s53-s54; DOI: 10.7861/clinmed.20-2-s53
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Introduction
    • Case presentation
    • Conclusion
    • Conflicts of interest
    • References
  • Figures & Data
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Haemopoietic stem cell transplantation is a curative treatment option with minimal transplant-related complications for patients with severe Glanzmann's thrombasthenia
  • The monitoring and incidence of hyperglycaemia in inflammatory bowel disease patients treated with intravenous steroids
  • Clinical dynamics of nephropathy in patients with diabetes mellitus type 2 and concomitant essential hypertensive disease
Show more Clinical

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians