Late-onset post-transplant lymphoproliferative disease presenting as massive occult gastrointestinal haemorrhage

Post-transplant lymphoproliferative disease (PTLD) is a widely-recognised complication of solid organ transplants with a myriad of clinical presentations. We report a 56-year-old Chinese woman who developed PTLD 17 years after a renal transplant. She initially presented with constitutional symptoms, and a diagnosis of diffuse large B-cell lymphoma was confirmed on liver biopsy. Staging computed tomography demonstrated widespread adenopathy. Initial treatment consisted of reduction of immunosuppression and Rituximab. Prior to institution of chemotherapy, she presented with life-threatening melaena. Laparotomy revealed a mid-jejunal ulcerating tumour which was resected. Histology confirmed necrotic diffuse large B-cell lymphoma and the cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy regime was subsequently commenced. The aim of this case report is to highlight the unique challenges in the management of PTLD in the context of an acute abdomen.