COVID-19 and Superimposed Aspergillosis in a Dual Organ Recipient with Diagnosed B-Cell Lymphoproliferative Disorder: A Rare Case Report and Literature Review

TL;DR

A rare case of post-transplant lymphoma in a dual organ recipient is complicated by infections and treatment challenges.

Contribution

This case report highlights the rare co-occurrence of PTLD, DLBCL, COVID-19, and aspergillosis in an organ transplant recipient.

Findings

PTLD as DLBCL was diagnosed in a kidney and pancreas transplant recipient with complex treatment complications.

Co-infection with COVID-19 and aspergillosis led to severe respiratory insufficiency and a fatal outcome.

Maintaining transplanted kidney function allowed standard chemotherapy despite multiple complications.

Abstract

Post-transplant lymphoproliferative disorder (PTLD) poses significant risks following organ transplantation, characterized by potential aggressiveness. This report aims to discuss a case of PTLD presenting as B-cell large-cell lymphoma (DLBCL) post kidney and pancreas transplantation. A 44-year-old female with type 1 diabetes underwent simultaneous cadaver kidney and pancreas transplantation. She presented with fever, night sweats, and weakness, revealing multiple lesions on CT, including in transplanted and native kidneys and pancreas. A biopsy of the transplant kidney confirmed PTLD, DLBCL subtype, with complex immunohistochemical findings. Chemotherapy (R-CHOP) was initiated but complicated by bowel perforation necessitating surgery and antibiotics, transplant renal vein thrombosis, pyelonephritis, and neutropenia. Despite the complications, the normal function of the transplanted kidney was maintained, which made it possible to implement the standard chemotherapy protocol. This case underscores the diagnostic challenges and therapeutic complexities of PTLD, specifically DLBCL, in transplant recipients. The co-infection of COVID-19 and aspergillosis in a multiple immunocompromised patient indicated a possible rapid course of the disease with global respiratory insufficiency and a fatal outcome despite all applied therapeutic modalities.

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