Hippokratia 1998, 2(3):139-143

Gr. Miserlis, G. Vergoulas, V. Papanikolaou, G. Imvrios, M. Leontsini, D. Takoudas, A. Antoniadis

Abstract

The aim of this case report was to describe the course and successful management of a renal transplant recipient, who presented thyroid cancer and Hodgkin lymphoma. The male patient KN, who was 35 years old, had an uneventful cadaver renal transplantation on 8th of April 1990 and was put on quadruple sequential immunosuppression. Two months later he presented Epstein - Barr virus infection (fever, headache, serologic conversion) while having normal graft function (Scr 1, mg/dl). Gancyclovir iv (DHPG) (5 mg/KgBW/12h) for 14 days and acyclovir p.o. (800 mgx4/d) for two months were given. At the same time azathioprine and cyclosporine were reduced drastically and patient's symptoms disappeared. Seven months later the patient presented thyroid cancer. Left thyroid lobe was dissected and he was put on thyroxin. On 20th of November 1993 patient's clinical examination revealed palpable neck lymph nodes and hepatosplenomegaly. Histological examination of the lymph nodes showed Hodgkin lymphoma, type 3, gradeIIA. At the same time thyroid right lobe was dissected because of relapse of thyroid cancer in situ. Azathioprine and cyclosporine were stopped and chemotherapy (MOPP/ABV) with local irradiation was given. Patient's clinical course was uneventful until 1997, when he had an acute rejection episode for which he was given methylopredisolone pulses. Today the patient has stable renal function (Scr 1,8 mg/dl), normal hematologic picture and he is under triple drug immunosuppression. During the nine year follow-up he became father twice and has a full time work. This case report, the first in the literature, shows that successful management of thyroid cancer and Hodgkin's lymphoma in transplant recipient is feasible without impairment of graft function.

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