Mycobacterium kansasii (M. kansasii) is a nontuberculous mycobacterium, which mainly infects the lungs in immunocompromised patients. We present here the case of a 27-year-old immunocompetent patient who developed pulmonary-renal syndrome, manifested with lung cavitation, miliary nodules, and necrotizing glomerulonephritis accompanied by elevated titers of myeloperoxidase antibody. Cultures from bronchoalveolar lavage were positive for M. kansasii, and the patient was treated with an anti-mycobacterial regimen. Additionally, given the presence of the myeloperoxidase antibody and glomerulonephritis on renal biopsy, our patient was diagnosed with microscopic polyangiitis (MPA). Unfortunately, the patient stopped his regimen and developed worsening respiratory failure and died. To our knowledge, this is the first case associating an M. kansasii infection with MPA, although more studies are needed to confirm this finding.

Kidney transplant recipients require lifelong immunosuppression to prevent organ rejection. The need for this intervention, however, leads to decreased cellular immunity and, in turn, increased risk of developing herpes zoster (HZ) from reactivation of latent varicella zoster virus. HZ commonly presents as a painful rash in a dermatome presentation followed by post-herpetic neuralgia. In immunosuppressed individuals, the presentation can be atypical and vary in severity depending on degree of immunosuppression and host immune response. We present the clinical course of 3 kidney transplant recipients who developed HZ after transplantation at different times post-transplant with varying clinical manifestations. The balance between maintaining immunosuppression and preventing or subsequently treating disseminated disease is discussed.