Epstein-Barr virus-related primary central nervous system lymphoma after cadaveric renal transplantation improved by treatment with high-dose methotrexate followed by irradiation.

A 57-year-old man was admitted to hospital because of motor aphasia on 16 September 2000. He had an approximate 2-year history of haemodialysis treatment, since April 1997, and had received a cadaveric renal transplantation in July 1999. Computed tomography and magnetic resonance imaging (MRI) revealed a mass with ringed enhancement in the left temporal-parietal lobe. Primary central nervous system (CNS) lymphoma (diffuse large B cell type) was diagnosed based on an open brain tumour biopsy. Epstein-Barr virus early RNA (EBER) in situ hybridization showed positive signals in the nuclei of the CNS lymphoma cells. A dose reduction of immunosuppressant and three series of high-dose methotrexate (MTX) therapy with leucovorine rescue followed by irradiation (whole brain irradiation, 30 Gy; partial brain tumour irradiation, 20 Gy) were carried out for his primary CNS lymphoma. The patient is currently in good condition (September 2004) with no enlargement of the lymphoma, as examined by MRI every 3 months, and preserved renal function.