Multifocal Hepatic Epstein-Barr Virus-Associated Smooth Muscle Tumor Mimicking Posttransplant Lymphoproliferative Disorder in a Renal Allograft Recipient.

Epstein-Barr virus-associated smooth muscle tumors (EBV-SMT) are rare neoplasms seen in immunocompromised patients and may mimic posttransplant lymphoproliferative disorder (PTLD). We report a 19-year-old renal transplant recipient presenting with abdominal symptoms and suspected PTLD. 18 F-FDG PET/CT demonstrated multiple hypermetabolic liver lesions. Histopathology confirmed EBV-SMT. Follow-up PET/CT after immunosuppression with mTOR inhibition demonstrated partial metabolic response. This case highlights the role of 18 F-FDG PET/CT in detecting multifocal disease, guiding biopsy, differentiating from PTLD, and assessing treatment response in EBV-SMT.