TY - JOUR T1 - Double-hit monomorphic B-cell lymphoma after liver transplantation JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2019-231831 VL - 13 IS - 1 SP - e231831 AU - Zabreen Tahir AU - Julia Peters AU - Kathleen Leahy AU - Felipe Batalini Y1 - 2020/01/01 UR - http://casereports.bmj.com/content/13/1/e231831.abstract N2 - We report the first case of double-hit (MYC and BCL-6) monomorphic post-transplant lymphoproliferative disorder in a patient status post liver transplantation. Our patient is a 71-year-old man with a past medical history of Budd–Chiari syndrome complicated by cirrhosis and hepatocellular carcinoma. He underwent a deceased donor liver transplantation 2 years prior to presentation and was maintained on tacrolimus and mycophenolate mofetil for immunosuppression. He presented with a 3-week history of classical B-symptoms. Initial workup was notable for elevated lactate dehydrogenase. Abdomen ultrasound revealed multiple hypoechoic lesions, raising suspicion for a post-transplant lymphoproliferative disorder. Biopsy showed pleomorphic large neoplastic cells throughout, consistent with a diagnosis of diffuse large B-cell lymphoma. Cytogenetics then revealed rearrangements in both MYC and BCL-6, consistent with double-hit lymphoma. His immunosuppressive regimen was subsequently tapered and he was started on DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab) regimen. ER -