Meningioma in a Postrenal Transplant Case: More than Meets the Eye

BACKGROUND: Patients with a renal transplant are an ever-increasing demographic. Their life expectancy is also on the rise and thus malignancies or tumors in these cases are more frequent. These patients are often on immunosuppressive drugs that are known to cause changes in the microvasculature, especially of the deep white matter. However, benign dural-based lesions are a rarity in these cases with very few (<5) ever being reported. Imaging findings in such cases are altered, which leads to an altered set of differential diagnosis. CASE DESCRIPTION: We present a case of a right parasagittal lesion in case of postrenal transplant with imaging findings suggestive of an inflammatory lesion. The lesion was excised and histopathology was that of a fibrous meningioma. Pathological basis of altered imaging is discussed and potential causes elaborated along with a thorough review of similar cases and their findings. CONCLUSIONS: Renal transplants and long-term survival are now a reality; calcineurin inhibitors are a staple for these cases. The drugs alter imaging findings and hence cases need to be carefully evaluated with a host of differential diagnosis. Knowledge of these changes is now necessary for these new spectra of cases.