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Subsequent intrathecal rituximab resulted in improvement of lesions on MRI and clearance of EBV from the cerebrospinal fluid (CSF). Mastoidectomy for biopsies from the mastoid and middle ear. Intrathecal treatment with rituximab. Imaging assessment of IAC lesion, CSF EBV titers, facial nerve function. Gradual resolution of IAC mass lesions, remission of PTLD, and facial improvement from House-Brackmann score of 4 to 3. PTLD causing facial paresis after autologous HSCT has not been previously reported and may be considered