A 36-year-old woman with a living donor kidney transplant from her sister 6 years ago presented with a serum creatinine of 1.9 mg/dL, from a baseline of 0.5 mg/dL 1 week prior to presentation. She had received the transplant after reaching kidney failure due to focal segmental glomerulosclerosis and she had been diagnosed with posttransplant lymphoproliferative disorder (PTLD) 2 years ago. Despite completion of therapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and subsequently ICE (ifosfamide, carboplatin, etoposide) 6 months ago, she experienced PTLD progression and new hypermetabolic lesions involving the liver and spleen were seen 1 month ago.