A Rare Case of Jejunal Perforation due to Post-transplant Lymphoproliferative Disease 27 Years after Liver Transplant
Journal of Transplant Surgery
Post-transplant lymphoproliferative disease (PTLD) is a well-known post-transplant malignancy common in both solid organ and stem cell transplants. The incidence of PTLD in adult liver transplant recipients is approximately 2.8%. While most often presenting in the first year after transplant, PTLD can occur at any time. This case report narrates a 61-year-old female with a history of liver transplant in 1992 for autoimmune hepatitis that was found to have a jejunal perforation due to PTLD 27 years later. The patient presented to the hospital with a fifteen hour history of left sided abdominal pain that was progressively worsening. The patient reports taking Imuran, Cellcept and Prednisone daily for immunosuppression. Computed tomography revealed pneumoperitoneum and free fluid centered on a focal area of enteritis in the proximal jejunum, as well as wall thinning of several areas of the small intestine. The patient was taken to the operating room for an exploratory laparotomy where a perforation was identified on the antimesenteric portion of the distal jejunum. A small bowel resection was performed and the patient's postoperative course was unremarkable. On pathologic analysis the patient was found to have a monomorphic, diffuse large B-cell lymphoma with a high proliferative rate. This case demonstrates a rare presentation of post-transplant lymphoproliferative disease occurring 27 years after transplantation.
Rosado M, Serena T, Martinez Z, Schwartz E, Mainster H. A Rare Case of Jejunal Perforation due to Post-transplant Lymphoproliferative Disease 27 Years after Liver Transplant. J Transplant Surg. 2021 June 23; 4(1):75-79. doi: 10.36959/338/337.