Post-transplant lymphoproliferative disorder (PTLD) represents a spectrum of Epstein-Barr virus (EBV)-related clinical diseases, from a benign mononucleosis-like illness to a fulminant non-Hodgkin's lymphoma. Because a large proportion of children are seronegative at the time of transplantation, recipients are at high risk of contracting primary EBV infection and subsequently developing PTLD. Surveillance techniques with antibody titers and/or polymerase chain reaction (PCR) may have a role in some high-risk settings. A 12-year-old boy whose serologic response to EBV was negative during follow-up after liver transplantation (LTx) developed Burkitt's lymphoma, a rare and the most severe variant of EBV-related PTLD, 32 months after LTx. He expired possibly due to side effects of treatment. We recommend that viral monitoring must be done using PCR during follow-up of pediatric LTx to prevent dramatic outcomes.