Rapidly Evolving Hepatic PTLD Mimicking Hepatic Abscesses in a Renal Transplant Recipient—A Case Study

Post-transplant lymphoproliferative disorder (PTLD) is a rare but potentially life-threatening complication of organ transplantation with highly variable clinical and diagnostic imaging manifestations. Hepatic involvement may mimic infection or primary hepatic malignancy, creating significant diagnostic challenges. The present case is of a 54-year-old renal transplant recipient who developed Epstein-Barr virus (EBV)-negative monomorphic PTLD manifesting as multifocal hepatic lesions, many years after transplantation. The initial sonogram demonstrated ill-defined heterogeneous hepatic lesions; however, a sonogram performed 5 days later showed rapid interval evolution with increasing heterogeneity and new central necrotic areas. This raised concern for evolving hepatic abscesses. Subsequent radiologic imaging demonstrated multifocal hepatic lesions with aggressive imaging features and systemic disease involvement. A biopsy confirmed EBV-negative diffuse large B-cell lymphoma-type PTLD. This case highlights the importance of recognizing the rapidly evolving sonographic appearances of hepatic PTLD and the value of multimodality diagnostic imaging correlation in transplant recipients, presenting with indeterminate hepatic lesions.