Gastrointestinal tuberculosis in renal transplant recipients: case report and review of the literature

Jarrett, Olamide D; Grim, Shellee A.; Benedetti, Enrico; Clark, Nina M.

doi:10.1111/j.1399-3062.2010.00540.x

Cited by 9 publications

(33 citation statements)

References 36 publications

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“…Moreover, potential pre-disposing factors for development of post-transplant TB include episodes of rejection [5,8,9], diabetes mellitus [9,10], longer pre-transplant period on hemodialysis [8], chronic liver disease, and co-existing infections [10]. In our patient, however, no predisposing factor was found.…”

Section: Discussionmentioning

confidence: 80%

“…Tuberculous appendicitis was diagnosed based on the report of caseating epithelioid granulomas in a histopathological examination of the resected appendix, together with positive mycobacterial cultures from the sputum and bronchial aspirate. The definite diagnosis of tuberculous appendicitis requires identification of the causative organism through culture or microbiological evaluation of the resected specimen [5]. Caseating epithelioid granulomas could be reported in a number of fungal infections including histoplasmosis, cryptococcosis, and coccidioidomycosis.…”

Section: Discussionmentioning

confidence: 99%

“…Although reports indicate an incidence of 0.1 to 3.0% for TB appendicitis in all appendectomies [6,7], prevalence of gastrointestinal TB in renal transplant recipients varies between 0.2% and 0.6% [5]. Extension from the ileocecal region and hematogenous spread are the major proposed mechanisms of appendiceal TB [5]. In non-transplant patients, abdominal pain is the most common presenting symptom of gastrointestinal TB [11].…”

Section: Discussionmentioning

confidence: 99%

“…In non-transplant patients, abdominal pain is the most common presenting symptom of gastrointestinal TB [11]. However, gastrointestinal bleeding followed by fever and abdominal pain was the most prevalent symptom in renal transplant recipients with gastrointestinal TB [5]. Jarrett and colleagues attributed these differences in presentation to decreased inflammatory response in immune-compromised patients [5].…”

Section: Discussionmentioning

confidence: 99%

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Concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant: a case report

2011

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IntroductionTuberculosis is still a serious infection among recipients of renal transplants. Although the ileocecal region is the most affected part in intestinal tuberculosis, acute tuberculous appendicitis is quite a rare entity. We report a case of concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant.Case presentationA 27-year-old Iranian woman, who had been the recipient of a renal transplant five years earlier, presented with a two-week history of coughing, fever and weight loss. The cause of her end-stage renal disease was chronic pyelonephritis. There were fine crackles noted during a chest examination, and a plain chest radiography showed fine miliary nodules throughout her entire lung fields. Sputum and bronchial aspirate examination was positive for acid-fast bacilli, suggestive of Mycobacterium tuberculosis infection. A chest computed tomography scan revealed widespread miliary nodules, compatible with miliary tuberculosis. She developed severe abdominal pain and abdominal surgery disclosed a perforated appendicitis. Histopathological examination of the resected appendix revealed widespread caseating epithelioid granulomas, suggestive of tuberculosis.ConclusionOur case report highlights a rare presentation of tuberculosis in a patient who has undergone renal transplant. Such unusual presentation of tuberculosis, particularly among patients receiving potent immunosuppressive protocols, should be considered by clinicians.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant: a case report

2011

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“…The prevalence of PTTB in renal allograft recipients is 0.3–1.7% in the United States and Europe,[245] but comparatively higher in the developing countries (3.1–15.2%). [126] Renal allograft recipients commonly present with extra-pulmonary TB (51.8%).…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis in a renal allograft recipient presenting with intussusception

et al. 2012

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Extra-pulmonary tuberculosis (TB) is more common in renal allograft recipients and may present with dissemination or an atypical features. We report a renal allograft recipient with intestinal TB presenting 3 years after transplantation with persistent fever, weight loss, diarrhea, abdominal pain and mass in the abdomen with intestinal obstruction. He was diagnosed to be having an ileocolic intussusception which on resection showed a granulomatous inflammation with presence of acid-fast bacilli (AFB) typical of Mycobacterium tuberculosis. In addition, AFB was detected in the tracheal aspirate, indicating dissemination. He received anti-TB therapy (ATT) from the fourth postoperative day. However, he developed a probable immune reconstitution inflammatory syndrome (IRIS) with multiorgan failure and died on 11th postoperative day. This is the first report of intestinal TB presenting as intussusception in a renal allograft recipient. The development of IRIS after starting ATT is rare in renal allograft recipients. This report highlights the need for a high index of suspicion for diagnosing TB early among renal transplant recipients and the therapeutic dilemma with overwhelming infection and development of IRIS upon reduction of immunosuppression and starting ATT.

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When an Infected Meniscus Portends a Perforated Viscus

Hannon¹,

Zachariah²,

Etherington³

et al. 2019

Infect Dis Clin Pract

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A 59-year-old woman with a status of post–renal transplant 7 years prior for autosomal dominant polycystic kidney disease on tacrolimus and mycophenolate mofetil presented with subacute left knee and right wrist pain. She received local steroid injections to both areas as an outpatient without improvement in her symptoms. She had recently traveled to India, her home country, to visit relatives. Aspiration of the knee revealed 4+ acid fast bacilli on smear, and she was taken for surgical debridement. She was started on empiric antibiotics for presumed infection with rapidly growing mycobacteria. Her course was complicated by acute onset abdominal pain with pneumoperitoneum and mesenteric abscess on imaging, requiring exploratory laparotomy. Surgical cultures from all sites were positive for Mycobacterium tuberculosis. Her medications were adjusted to rifabutin, isoniazid, pyrazinamide, and ethambutol. Pretransplant screening results were unknown. She was discharged in stable condition and completed 12 months of medical therapy.

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Gastrointestinal tuberculosis in renal transplant recipients: case report and review of the literature

Cited by 9 publications

References 36 publications

Concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant: a case report

Concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant: a case report

Tuberculosis in a renal allograft recipient presenting with intussusception

When an Infected Meniscus Portends a Perforated Viscus

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