Posttransplant lymphoproliferative disorder in an 11-year-old immunosuppressed boy

We present an 11-year-old boy who presented with symptoms of subacute facial nerve palsy after cardiac transplant. Neuroimaging revealed multiple ring-enhancing lesions that were most concerning for opportunistic organism abscesses and he was treated with broad-spectrum antifungal and antibacterial therapy. After noninvasive testing failed to identify a causative organism, he underwent brain biopsy. Pathology revealed posttransplant lymphoproliferative disease that was later determined to be isolated to the central nervous system. The patient was treated with reduction in his immunotherapy and chemotherapy including rituximab and methotrexate. This case exemplifies the importance of having a low threshold to consider posttransplant lymphoproliferative disease in posttransplant patients.