Primary tuberculosis 1 year after conversion from azathioprine to mycophenolate in recipient kidney transplantation: a case report

Skhiri, H.; Guedri, Y.; Souani, Y; Achour, Asma; Belhassen, S.; Frih, A.; Dhia, Ben; Elmay, M.

doi:10.1016/j.transproceed.2003.08.060

Cited by 8 publications

(7 citation statements)

References 9 publications

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“…Our study, conducted in the context of scarce information and a series of generally positive case reports, demonstrates a significant additional risk for adverse outcomes in multiple pregnancies in CKD patients (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). On a baseline of relatively high morbidity and mortality typical of multiple pregnancies, the availability of a large control group allowed comparison with low-risk twin pregnancies, performed by considering all twin pregnancies together or by limiting the analysis to the more common subset of dichorionic dizygotic twins (Table 2) (33,34).…”

Section: Discussionmentioning

confidence: 95%

“…To note, there were no significant differences in baseline characteristics in CKD patients and controls, except for the week of referral, occurring later in the unit dedicated to kidney diseases in pregnancy. The referral week was similar for patients with and without CKD in the outpatient unit dedicated to twins; as a rule, the patients with CKD were referred earlier to the twins unit (median week of referral, 13 weeks; range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] than to the CKD unit (median week of referral, 22 weeks; range, 6-33). CKD was discovered in pregnancy in 10 of 20 patients; the two units work together and the patients are referred to the CKD unit after having performed blood and urine tests and kidney ultrasounds, hence the delay between first suspicion of CKD, diagnosis, and referral ( Table 1).…”

Section: Overall Datamentioning

confidence: 99%

“…This is the case with multiple pregnancies in CKD patients. Except for a few patients in the context of larger series, only sporadic, exceptional cases have been reported, many of which are in the context of kidney transplantation (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Most of the available cases reported successful outcomes, presumably because of a baseline bias, probably a joint effect of the comprehensible unwillingness to report patients with a poor outcome, and of publication bias (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

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Multiple Pregnancies in CKD Patients

Piccoli

Arduino

Attini

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives CKD and multiple pregnancies bear important risks for pregnancy outcomes. The aim of the study was to define the risk for adverse pregnancy-related outcomes in multiple pregnancies in CKD patients in comparison with a control group of "low-risk" multiple pregnancies.Design, setting, participants, & measurements The study was performed in the Maternal Hospital of the University of Turin, Italy. Of 314 pregnancies referred in CKD (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011), 20 were multiple (15 twin deliveries). Control groups consisted of 379 low-risk multiple pregnancies (314 twin deliveries) and 19 (15 twin deliveries) cases with hypertension-collagen diseases. Baseline data and outcomes were compared by univariate and logistic regression analyses.Results The prevalence of multiple pregnancies was relatively high in the CKD population (6.4%); all referred cases were in early CKD stages (I-II); both creatinine (0.68 to 0.79 mg/dl; P50.010) and proteinuria (0.81 to 3.42 g/d; P50.041) significantly increased from referral to delivery. No significant difference in demographic data at baseline was found between cases and low-risk controls. CKD was associated with higher risk of adverse pregnancy outcomes versus low-risk twin pregnancies. Statistical significance was reached for preterm delivery (,34 weeks: 60% vs 26.4%; P50.005; ,32 weeks: 53.3% vs 12.7%; P,0.001), small for gestational age babies (28.6% vs 8.1%; P,0.001), need for Neonatal Intensive Care Unit (60% vs 12.7%; P,0.001), weight discordance between twins (40% vs 17.8%; P50.032), and neonatal and perinatal mortality (6.6% vs 0.8%; P50.032).Conclusion This study suggests that maternal-fetal risks are increased in multiple pregnancies in the early CKD stages.

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Section: Discussionmentioning

confidence: 95%

Section: Overall Datamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multiple Pregnancies in CKD Patients

Piccoli

Arduino

Attini

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…48 Few reports documented the reactivation of TB in patients whose regimen had switched from azathioprine to mycophenolate mofetil. 49,50 At the moment there are no standard recommendations for TB screening, treatment, or prophylaxis in patients on anti-metabolites or calcineurin inhibitors.…”

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confidence: 99%

Ocular Tuberculosis—A Clinical Conundrum

Lee

Agrawal

Pavésio

2015

Ocular Immunology and Inflammation

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“…It is therefore no surprise that infections are a common complication as both humoral and cellular immunity are profoundly suppressed. 11 , 12 However, when compared with the older agent cyclophosphamide, MMF causes less bone marrow suppression and hence is associated with less infectious complications. 7 , 10 When compared with azathioprine, the other first-line agent in the treatment of LN, studies have not shown a difference in rates of infection.…”

Section: Discussionmentioning

confidence: 99%

Miliary Tuberculosis Presenting With Meningitis in a Patient Treated With Mycophenolate for Lupus Nephritis: Challenges in Diagnosis and Review of the Literature

Macauley

Rapp

Park

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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Tuberculosis is one of the top 10 causes of death worldwide according to the World Health Organization. Central nervous system involvement is usually the least common presentation of tuberculosis occurring in about 1% of all cases but yet can have very devastating outcomes. Lupus nephritis is one of the most common complications of systemic lupus erythematosus with up to two thirds of patients presenting with some degree of renal dysfunction. The mainstay of treatment is glucocorticoids; however, to sustain remission, steroid sparing agents such as cyclophosphamide, azathioprine and mycophenolate mofetil are used. Such patients, in addition to their baseline dysfunctional immune system, have a heightened risk of infections due to these drugs. In this article, we present a young woman who had recently been started on mycophenolate mofetil for control of class V lupus nephritis who presented with headaches, sinus pressure, and fevers. She had a protracted course of hospitalization as she failed to improve clinically and to respond to conventional therapy for acute bacterial sinusitis and meningitis. She was empirically started on antitubercular therapy 9 days after hospitalization. The diagnosis was not confirmed until day 18, the day results of cerebrospinal fluid acid-fast bacillus culture was reported. This case is reported to highlight the challenges in diagnosing Mycobacterium tuberculosis infection in an immunocompromised state and to demonstrate that its presentation can mimic numerous other conditions. Clinicians must maintain a high index of suspicion of Mycobacterium tuberculosis infection in such patients who present with nonspecific or unexplainable symptoms.

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Primary tuberculosis 1 year after conversion from azathioprine to mycophenolate in recipient kidney transplantation: a case report

Cited by 8 publications

References 9 publications

Multiple Pregnancies in CKD Patients

Multiple Pregnancies in CKD Patients

Ocular Tuberculosis—A Clinical Conundrum

Miliary Tuberculosis Presenting With Meningitis in a Patient Treated With Mycophenolate for Lupus Nephritis: Challenges in Diagnosis and Review of the Literature

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