A 7-year-old girl presented with multiple complaints, including fever, nausea and fatigue, 5 months after a multivisceral transplant for pseudo-obstruction. A chest radiograph showed pulmonary nodules (curved arrows) and a diffuse nodular appearance of the stomach (straight arrows) (Fig. 1). A CT revealed innumerable enhancing pulmonary nodules, mediastinal adenopathy, diffuse nodularity of the gastric wall (curved arrows) and bilateral renal masses (straight arrows) (Fig. 2). A biopsy of polypoid gastric lesions revealed Epstein-Barr virus (EBV)-associated post-transplantation lymphoproliferative disorder (PTLD).

Fig. 1
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Frontal chest radiograph

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Fig. 2
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Axial CT image

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PTLD refers to a group of diseases ranging from lymphoid hyperplasia to neoplasia and can be intranodal or extranodal. Most cases are associated with B-lymphocyte proliferation and EBV infection [1]. PTLD usually occurs within 1 year of transplantation and is most prevalent in multivisceral transplant recipients [2]. Although intra-abdominal organs are most frequently affected, particularly the liver and GI tract, sites of involvement vary with the type of allograft [2]. Imaging features depend on the organs involved, and tissue sampling is required for diagnosis and classification.