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Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation. PTLD is the disorder arising from the combined effects of Epstein-Barr virus associated lymphoproliferation with the disruption of the normal immune control of cytotoxic T cells. The only effective treatment of PTLD is often the reduction or elimination of intense immunosuppressive therapy. But we presented here a case of severe acute rejection developed in orthotopic liver transplantation patient after discontinuing the immunosuppression. A 58 year-old male had a liver transplantation for hepatitis B viurs-associated liver cirrhosis and taking cyclosporine postoperatively. He presented two months later with palpable neck mass and abdominal pain. CT scan showed multiple lymphadenopathies in retroperitoneum and more than 3 cm conglomerulated mass in left supraclavicular area. Percutaneous needle biopsy was done in which a this neck mass proved not to be a infectious mononucleosis-like disease or a definite lymphoma. In situ hybridization (ISH) for EBV encoded RNA was positive in a few cell. It suggested a possibility of PTLD, Even though the lymph node is totally necrotic in the given specimen. At that time, the immunosuppression was discontinued, and he was treated with iv gancyclovir. No chemothreapy was administered. Two weeks later, severe acute rejection (RAI=7) followed requiring treatment with steroid pulse. Tacrolimus had replaced cyclosporine and was maintained. Liver function test profile decreased gradually. Serial CT scan showed partial improvement of multiple necrotic lymphadenopathy in the retroperitoneum and supraclavicular area. Two months later, he presented with palpable neck mass and abdominal pain repeatedly. Another incisional biopsy was performed. The results showed B cell lymphoma with CD20 (+), CD3 (-), bcl6 (-), Ki-labelling index 80%, bcl (-), p53 (-). He received 2 courses of cyclophosphamide (600 mg/m2, on day 1 of each course) and prednison (2 mg/kg/day for 5 day). The first 2 courses were given in combination with 4 weekly doses of rituximab (375 mg/m2, i.v). After symptomatic improvement, he was discharged. (J Korean Soc Transplant 2005;19:79-84)
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