A 66-year-old female kidney transplant recipient was admitted for evaluation of severe fatigue, a 25 kg weight loss over 5 months, and a rapidly progressive purpura. Twelve months earlier, she had received a deceased-donor kidney transplant owing to malformative uropathy. Induction immunosuppression included antithymocyte globulin and high-dose corticosteroids, followed by maintenance therapy with low-dose prednisolone, tacrolimus (trough levels of 5-6 μg/L), and mycophenolate mofetil.