8-year-old boy was admitted after a two-week history of dyspnea followed by a two-day history of left eye ptosis and diplopia. His past medical history was significant for a single ventricle cardiac physiology, status post orthotopic heart transplant 6 years prior, as well as primary ciliary dyskinesia and hypersensitivity pneumonitis. His management included an immunosuppressive regimen of mycophenolate mofetil, prednisone, and tacrolimus. He had bilateral cervical and axillary lymphadenopathy as well as an excoriated skin rash, severe interstitial lung disease and third cranial nerve thickening. A FDG-PET/CT showed extensive hypermetabolic lymphadenopathy involving the cervical, bilateral axillary, mediastinal, hilar, retroperitoneal and iliac regions.