Ratuapli et al. Journal of Medical Case Reports 2011, 5:5 http://www.jmedicalcasereports.com/content/5/1/5 Page 6 of 8 Figure 6 EGD showing large ulcerated gastric nodule together with large nodules in the duodenum. a putative role of EBV has been suggested in 89% of cases of B-cell PTLD [9], no direct role for this lympho- tropic virus has been confirmed in T-cell PTLD. EBV infects and immortalizes B cells causing unchecked pro- liferation of EBV-infected cells, as the critical T-cell control of B-cells is lacking in immunosuppressed patients [10]. Human T-cell Lymphotropic Virus 1 (HTLV1) has been reported to cause post renal trans- plant T-cell lymphomas in Japan [11], due to a higher prevalence of the virus among hemodialysis patients. Our case was unusual in that the lymphoma tested posi- tive for EBV, even though it was of T-cell origin, which is only seen in a small minority of patients [12]. The initial step in treating PTLD is reduction in immunosuppression, and the response is usually seen in three to four weeks, resulting in long term remission in 25% to 63% [13] of adults. Early polyclonal PTLD responds well to a reduction in immunosuppression, whereas monoclonal PTLD generally does not respond to the reduction and has a high mortality rate of 50% to 90% [14]. Early use of anthracycline-based chemotherapy results in long term disease free survival rates of 50% to 60% in monoclonal B-cell lymphomas [15], whereas T-cell PTLD responds very poorly. There are no stan- dardized chemotherapy regimens for PTLD in general and for the T-cell phenotype in particular. Multiple treatment regimens such as CHOP, VAPEC-B (Adria- mycin, etoposide, cyclophosphamide, methotrexate, bleomycin and vincristine), anti-IL-6 mAb, bexarotene and antiviral agents have been used with varied results. Other salvage regimens for high-grade lymphomas have also been suggested in the literature [14,15].