Intestinal perforation associated with rituximab therapy for post-transplant lymphoproliferative disorder after liver transplantation

Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after organ transplantation with a cumulative incidence of 1.1% at 18 months and 4.7% at 15 years. It has been reported in patients with or without concomitant Epstein–Barr virus infection. Therapy ranges from a reduction of immunosuppression to administration of conventional cytotoxic chemotherapy. Rituximab, a recombinant chimeric anti-CD20 monoclonal antibody has been used for the treatment of PTLD with promising results and a reduction in treatment-associated mortality. However, the use of rituximab has been associated with spontaneous gastrointestinal perforation. We describe a case of recurrent intestinal perforations after a single dose of rituximab.