31st May 2023

A 52-year-old male is reviewed in the renal clinic with symptoms of general malaise

A 52-year-old male is reviewed in the renal clinic with symptoms of general malaise. On examination, small volume lymphadenopathy can be felt in the cervical region bilaterally. His past medical history is remarkable for a renal transplant one year ago for polycystic kidney disease. He remains on tacrolimus and mycophenolate therapy.

Bloods demonstrate an elevated EBV PCR, and PET CT shows supraphysiological avid uptake in the cervical regions only. He has an excision biopsy performed which shows plasmacytic hyperplasia and EBV infected B-lymphocytes.

Based on the likely diagnosis, which is the most appropriate initial management?