Abdominal Compartment Syndrome in Rapidly Progressive Lymphoproliferative Disorder Following Kidney Transplantation

Figure

18F-fluorodeoxyglucose (FDG) positron emission tomography uses FDG as a glucose analog to visualize local metabolic activity, while low-dose computed tomography is performed for the accurate localization of metabolically active areas and for attenuation correction. This yielded evidence of a small number of cervical (asterisk), thoracic, and, in particular, abdominal (arrows) tumor manifestations exhibiting intense metabolic activity. Here, the standardized uptake value (SUV) is the quantitative measure of the regional concentration of radioactivity: The higher the value, the brighter the region appears on morphological imaging. The transplanted kidney is located in the right iliac fossa (triangle).

A 27-year-old male kidney transplant recipient presented with a 7-week history of abdominal pain. In addition, the patient’s inflammatory markers were found to be elevated. Magnetic resonance imaging revealed colonic wall thickening and retroperitoneal lymphadenopathy; sigmoidoscopy was normal. An ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan to investigate malignancy 11 days following initial imaging showed metabolically active tumor lesions surrounding all intra-abdominal organs (Figure). Histological analysis of a lymph node revealed an EBV-negative B-cell lymphoma in the form of a post-transplant lymphoproliferative disorder (PTLD), which is a serious malignant complication of immunosuppression with a limited prognosis. Treatment was initiated with rituximab but escalated to CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) upon tumor progression. As a complication, elevated intra-abdominal pressure led to abdominal compartment syndrome with organ dysfunction due to impaired microcirculation and venous congestion, requiring endoscopic decompression, etoposide-based chemotherapy, and local radiotherapy. In the further course, the compartment syndrome resolved, and PET imaging demonstrated treatment response with a marked reduction in tumor volume. This case highlights the importance not only of rapid diagnosis in kidney transplant recipients presenting with persistent abdominal pain but also of prompt and consistent treatment escalation in cases of PTLD.

Dr. med. Amélie Friederike Menke, Prof. Dr. med. Stefan Reuter,
Universitätsklinikum Münster, Medizinische Klinik D (Allg. Innere Medizin und Notaufnahme, Nieren- und Hochdruckkrankheiten und Rheumatologie, Münster;

PD Dr. med. Wolfgang Roll, Universitätsklinikum Münster, Klinik für Nuklearmedizin, Münster

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Menke AF, Roll W, Reuter S: Abdominal compartment syndrome in rapidly progressive lymphoproliferative disorder following kidney transplantation. Dtsch Arztebl Int 2025; 122: 645. DOI: 10.3238/arztebl.m2025.0150