Subacute immune response to primary EBV infection leading to post‐transplant lymphoproliferative disease in a renal transplant patient

A 23‐year‐old man sero‐negative for Epstein–Barr virus (EBV) developed recurrent sore throats 3 and 6 months after a renal transplant from an EBV sero‐positive donor. Tonsillar biopsy at 9 months post‐transplant showed post‐transplant lymphoproliferative disease (PTLD) caused by EBV. Following reduction of immunosuppressive treatment, he developed further signs and symptoms, and serological evidence of infectious mononucleosis followed by resolution of lymphadenopathy. This case emphasizes the difficulty in interpreting EBV serology in immunosuppressed patients and the importance of pre‐transplant EBV serology.