Resumen
Los síndromes linfoproliferativos postrasplante (PTLD, por sus siglas en inglés) constituyen una complicación relativamente frecuente entre los receptores de trasplante de órgano sólido o de médula ósea. Representan un amplio espectro de lesiones, que oscilan desde los cambios histológicos tempranos producidos por la infección del virus de Epstein-Barr hasta las neoplasias de alto grado con respuestas variables a las intervenciones terapéuticas. El compromiso del sistema nervioso central (SNC) se ha descrito hasta en 22% de los casos, 12% de ellos en forma primaria, asociados a un peor pronóstico; en general el abordaje diagnóstico y terapéutico no está estandarizado, en parte, debido a la limitación fisiológica que implica la barrera hematoencefálica. El tratamiento tiene opciones limitadas; se acepta el uso de metotrexate a altas dosis o de rituximab intravenoso o intratecal. A continuación, se presenta el caso de un hombre de 76 años, receptor de un trasplante hepático por hemocromatosis, quien a los 6 años postrasplante consulta por alteración de la marcha. Tras documentar una lesión intra-axial, la biopsia por estereotaxia documenta un PTLD tardío, primario con lesión única en SNC. Después de la reducción inicial de la inmunosupresión, el tratamiento con rituximab y metotrexate intravenosos a altas dosis durante cinco ciclos, se logró respuesta parcial en este paciente, con toxicidad renal leve.
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