The cryptic enemy: Exploring paraneoplastic manifestations of lymphoma through a case of jejunal lymphoma in a renal transplant recipient

Introduction: Lymphoproliferative disorders are commonly associated with paraneoplastic manifestations which might precede the onset of the neoplasm. Therefore, high index of suspicion in at-risk populations can help early detection of the lymphoma.Case history: A young female presented with anaemia and diarrhoea eighteen months after the kidney transplant and was diagnosed to have stage IV jejunal lymphoma with pelvic skeletal deposits. She had an episode of left sacroiliitis nine-months prior to this. The original renal disease that rapidly progressed to end-stage-kidney failure was membrano-proliferative glomerulonephritis. Current presentation was complicated by possible cardiac autonomic failure.Discussion and conclusion: Sacroiliitis, glomerulonephritis and cardiac autonomic failure are well known paraneoplastic manifestations of lymphoma. All three can precede lymphoma by years or present simultaneously. While our patient was at risk of post-transplant lymphoproliferative disorders (PTLD), we postulate whether the glomerulonephritis and sacroiliitis could have been paraneoplastic. Malignancy related sacroiliitis can be paraneoplastic or related to skeletal deposits. It can seemingly respond to anti-inflammatory therapy. Thorough evaluation of adult onset glomerulonephritis is required to exclude an underlying malignant aetiology. We highlight the importance of protocol based complete analysis of seemingly benign and unrelated conditions which might help discover underlying sinister aetiologies and thereby help change the natural history of both.