Scoping review finds 37 opportunistic infections mimicking PTLD in transplant recipients

A scoping review identified 37 cases in 35 studies of transplant recipients whose opportunistic infections were initially suspected to represent post-transplant lymphoproliferative disorder (PTLD). The reported conditions ranged across bacterial, fungal, parasitic and viral infections and could resemble PTLD clinically, radiologically or histopathologically. Most cases involved solid organ transplant recipients, and diagnostic delays led to PTLD-directed treatment in several patients. These delays were associated with severe complications, including graft dysfunction and death, according to the review.

Investigators followed PRISMA-ScR guidance and searched PubMed, PubMed Central and EMBASE through September 30, 2025, for reports of opportunistic infections initially suspected as PTLD in transplant recipients. They extracted information on patient demographics, transplant characteristics, pathogens, clinical presentation, diagnostic evaluation, management and outcomes, then summarized the data descriptively. Thirty-five studies reporting 37 individual cases met the inclusion criteria. The median patient age was 44.5 years, and the median interval between transplantation and clinical presentation was 48 months.

Solid organ transplant recipients accounted for 97% of the included cases, with kidney transplantation the predominant transplant type. Bacteria accounted for 51% of the infections, led by Bartonella henselae, while fungal infections represented 27%, parasitic infections 14% and viral infections 8%. The distribution demonstrates that PTLD-like infectious presentations are not confined to a single pathogen class. It also shows that the review’s diagnostic focus encompassed several mechanisms of mimicry occurring across a broad range of pathogens and organ systems.

Radiological resemblance was the predominant mechanism that prompted suspicion of PTLD. However, the review found that imaging findings and Epstein–Barr virus-associated laboratory abnormalities lack specificity for the disorder. Histopathological examination ultimately established the correct diagnosis in most cases. Tissue biopsy, combined with pathogen-specific microbiological or molecular testing, was central to diagnosis. The investigators therefore emphasized integrating tissue assessment with targeted infectious-disease testing before initiating treatment directed at PTLD.

The review describes a pattern of diagnostic uncertainty in which clinicians initially treated the condition as PTLD before identifying an infectious cause. Several such delays were associated with graft dysfunction and death. Because the evidence was synthesized from individually reported cases rather than a controlled comparison of diagnostic strategies, the findings identify important mimicry patterns but do not establish the effectiveness of a particular testing protocol. The authors concluded that greater awareness of opportunistic infections as PTLD mimics may help reduce diagnostic error, preserve graft function and improve outcomes in transplant recipients.

Subject of Research: Opportunistic infections mimicking post-transplant lymphoproliferative disorder in transplant recipients

Article Title: Opportunistic infections mimicking post-transplant lymphoproliferative disorder in transplant recipients: a scoping review of reported cases

Article References: Fathi, H., Saadat, S. H., Javanbakht, M., Rostami, Z., Cegolon, L., & Einollahi, B. (2026). Opportunistic infections mimicking post-transplant lymphoproliferative disorder in transplant recipients: a scoping review of reported cases. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14295-2

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14295-2

Keywords: PTLD, transplant recipients, opportunistic infections, solid organ transplantation, scoping review, Bartonella henselae, diagnostic mimicry, tissue biopsy, graft dysfunction, infectious diseases, Opportunistic, infections