Posttransplant lymphoproliferative disorder coexisting with extrapulmonary tuberculosis: A diagnostic dilemma

Solid organ transplant recipients have a higher risk of malignancy and infections. We present a case of deceased donor renal transplant recipient diagnosed to have co-existing tuberculoma and CNS-PTLD. 61 year old male who underwent deceased donor renal transplantation and was given induction with Anti-Thymocyte globulin, continued on triple immunosuppression (Tacrolimus, Mycophenolate mofetil and Prednisolone). He developed New onset diabetes after transplantation and had multiple infections. He presented with bilateral multiple space occupying lesions on MRI brain. MRI spectroscopy from parietal region was suggestive of Tuberculoma. ATT was started and patient improved. He presented after 4 weeks with ataxia and slurring of speech, MRI brain showed regression in lesion of right parietal area, but a new lesion appeared in the left parieto-occipital region along with an enlarged left cerebellar lesion. Decompressive craniotomy and excision of lesion in left cerebellum, was done. Histology confirmed Non-Hodgkin's Lymphoma, diffuse Large B-cell type. He was treated with whole brain radiotherapy. Repeat MRI brain after 6 months demonstrated a near total clearance of lesions.