Clinical Report: Post-Transplant Lymphoproliferative Disorder Presenting as Baló’s Concentric Sclerosis

Overview

This case report details a 37-year-old female patient diagnosed with monomorphic Primary Central Nervous System PTLD, initially misidentified as Baló’s concentric sclerosis. The patient responded to a treatment regimen that included immunosuppression reduction and rituximab plus lenalidomide.

Background

Post-Transplant Lymphoproliferative Disorder (PTLD) is a serious complication in transplant recipients, characterized by the malignant transformation of lymphoid tissue due to immunosuppression. Accurate diagnosis is critical, as PTLD can mimic other conditions, complicating management and treatment strategies. This case highlights the importance of distinguishing PTLD from similar disorders like Baló’s concentric sclerosis.

Data Highlights

No numerical or trial data available in the source material.

Key Findings

• The patient presented with rapidly progressive left hemiparesis over four days.
• Initial MRI findings were suggestive of Baló’s concentric sclerosis.
• Pathological biopsy confirmed a diagnosis of monomorphic Primary Central Nervous System PTLD.
• The patient showed a partial remission following treatment with immunosuppression reduction and rituximab plus lenalidomide.
• Both PTLD and Baló’s concentric sclerosis can improve with high-dose corticosteroid therapy, complicating differential diagnosis.

Clinical Implications

Clinicians should consider PTLD in transplant recipients presenting with neurological symptoms and MRI findings resembling demyelinating diseases. Early biopsy and appropriate treatment can lead to improved outcomes.

Conclusion

This case underscores the necessity for careful diagnostic evaluation in transplant recipients to differentiate between PTLD and other similar conditions, ensuring timely and effective management.

Related Resources & Content

1. IARC Publications Website, WHO-HAEM5, 2024 -- Haematolymphoid Tumours
2. NCCN Guidelines® Insights: B-Cell Lymphomas 3.2025 - PubMed
3. Acta Neuropathologica — Antibody Profiles in Patients with Histologically Characterized Patterns of Multiple Sclerosis
4. Retinal Physician — Ocular Tumor Masquerade Syndromes
5. Frontiers in Medicine — Case Report: Individualized management of tuberous sclerosis complex-associated lymphangioleiomyomatosis
6. Blood Cancer Journal — Effectiveness of Bortezomib and Thalidomide in Treating Recurrent Multicentric Mixed-Type Castleman's Disease
7. IARC Publications Website - Haematolymphoid Tumours
8. NCCN Guidelines® Insights: B-Cell Lymphomas 3.2025 - PubMed
9. FDA Issues New CRL for Tabelecleucel in Epstein Barr Virus–Positive PTLD | CancerNetwork