Early-Onset Epstein-Barr Virus (EBV)-Positive Post-transplant Lymphoproliferative Disorder Presenting With Catastrophic Gastrointestinal Hemorrhage and Ischemic Bowel Following Kidney Transplantation.

Post-transplant lymphoproliferative disorder (PTLD) is a rare but fatal outcome following solid organ transplant, which is often associated with Epstein-Barr virus (EBV) infection or immunosuppression. Subsequent gastrointestinal involvement is uncommon and can lead to severe complications. We describe a 58-year-old male who developed EBV-associated PTLD within six months of a deceased donor renal transplant who presented with persistent severe gastrointestinal bleeding. Multiple surgical resections were required as the patient also developed progressive ischemic bowel disease. Despite immunosuppression reduction, rituximab therapy, and surgical intervention, his condition worsened and led to multi-organ failure and eventually death. This case highlights the aggressive clinical course of gastrointestinal-associated PTLD and the challenges in diagnosis and management. Early recognition with multidisciplinary care is critical for treatment, but may be insufficient in cases with advanced disease. EBV monitoring and tailored immunosuppression in transplant recipients are also essential in improving outcomes in high-risk patients.