گزارش یک مورد گلیوبلاستوما در گیرنده 18 ساله کلیه از فامیل

    Introduction: From 1986 to 2005, for 20 years about 2010 renal transplantations(TX) have been performed in our center mainly from unrelated kidney donor. Various bacterial, viral, fungal infections and malignancy after transplantation have been reported due to use of suppressive medications. After 20 years of experience with kidney transplantation in Iran, there are many reports of various malignancies. Case Report: The patient was an 18 year old girl who had been under maintenance hemodialysis(HD) for 6 months. She underwent renal Tx from her father in March 2004. Pathological diagnosis of her native kidney was reflux nephropathy. She had an episode of rejection during the first month and was treated with anti lymphocyte globulin(ALG). Two months after renal Tx we planned to discharge the patient on triple immunosuppressive therapy with excellent allograft function. (Cyclosporine 150mg per day, Mycophenolate Mophtyl 1mg per day, Prednisolone 7.5 mg). Patient was readmitted in our center with fever, severe hirsutism and lower extremity weakness cyclosporine toxicity and CMV infection was suggested. Treatment with gancyclovir was started and cyclosporine dosage reduced. CMV serologic test was positive significantly. IV gancyclovir and 2 months oral anti CMV therapy was initiated for the patient and dosage of cyclosporine reduced to 100 mg/daily. Five months after renal TX, patients was readmitted for progressive lower extremity weakness without focal neurological symptoms 2 episodes of convulsion was noted clinically with normal renal function. On the first day of admission, CT of brain was done. Three space occupaying lesions with different sizes were noted. Brain abscess, toxoplasmosis and CNS malignancy were 3 differential diagnoses in neurologic and neurosurgical consultation. Unfortunately under severe investigation and therapeutic strategies, patient died 2 weeks after admission with functional graft. Brain biopsy showed glioblastoma of brain. Conclusion: With the very interesting CT finding we conclude that in patients with lower extremity weakness other diagnoses besides drug toxicity must be considered. Also it is possible that occult glioblastoma, which is a rare and uncommon malignancy, was provocated with immunosuppression.