Simultaneous Presentation of Post-Transplant Lymphoproliferative Disorder (PTLD) and Acute Cellular Rejection (ACR) in a Liver Transplant Recipient: A Therapeutic Conundrum.

We report a 64-year-old liver transplant recipient who developed early nondestructive post-transplant lymphoproliferative disorder (PTLD) and severe acute cellular rejection (ACR) concurrently. Hepatic lymphadenopathy led to a liver biopsy demonstrating early PTLD. Immunosuppression (IS) was reduced for early PTLD, which led to acute liver injury requiring high-dose steroids. However, subsequent augmentation in immunosuppression for ACR led to progression of PTLD, requiring rituximab treatment. This case highlights the complexity of managing conflicting liver transplant complications and underscores the importance of a multidisciplinary approach. In our case, prioritizing the treatment of rejection preserved the allograft function. Long-term follow-up showed complete resolution of both rejection and PTLD.