A CASE REPORT OF IMMUNOSUPRESSION RELATED COMPLICATIONS IN A KIDNEY  TRANSPLANTED PATIENT

Adrijana Spasovska Vasilova; Sanja Trajkova; Elena Simonovska; Simona Stojanoska Godjoska; Ana Stojanoska; Igor Nikolov; Irena Rambabova Bushljetik; Lada Trajcheska; Goce Spasovski

Adrijana Spasovska Vasilova University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
Sanja Trajkova University Clinic of Hematology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
Elena Simonovska University Clinic for Pediatric Diseases, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
Simona Stojanoska Godjoska Institute of Pathology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
Ana Stojanoska University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
Igor Nikolov University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
Irena Rambabova Bushljetik University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
Lada Trajcheska University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
Goce Spasovski University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia

Abstract

Immunosuppressed transplant recipients have a higher rate of prolonged survival with a functioning graft, but also prolonged exposure to complications of chronic immunosuppression. Registry data found cancer to be the third most common cause of death after cardiovascular accidents and infections in these patients. In the following case, we present a kidney transplanted patient, successfully treated for Diffuse large B-cell lymphoma, generalized Herpes Zoster, and CMV infection. The patient was a 60 years-old man with a kidney transplant from a cadaver 5 years ago. After the transplantation, no complications occurred. He regularly referred for medical monitoring, and was adherent to medical treatment and investigations. His long term immunosuppressive therapy consisted of a low dose of corticosteroids, tacrolimus, and mycophenolic acid. The patient presented with acute pain and tenderness all over the abdomen that lasted for a few hours. After CT imagining confirmed intussusception at left colic flexure, urgent surgery was performed. Tissue sampling diagnosed Large B-cell lymphoma. The patient underwent 4 cycles of dose-rationalized R-CHOP therapy with a normal PET scan afterward. Herpes Zoster generalized infection and CMV occurred in two months. Treatment with acyclovir was successful. The regular immunosuppressive regime was re-introduced, consisting only of corticosteroids and sirolimus. The creatinine level remained stable for the next two years, and all subsequent PET scans and CT images were in normal range. The patient remained free of infections as well.

Key words: kidney, transplant, immunosuppression, B-cell lymphoma, malignicy.

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