Tuberculosis dissemination in kidney transplant recipient treated with anti-CD40 monoclonal antibody: a case report

Abstract

Background Tuberculosis (TBC) in solid organ transplant recipients represents a severe complication. The incidence among transplant recipients is higher than in the general population, and the diagnosis and treatment remain challenging. We present a case of active disseminated tuberculosis in a kidney transplant recipient treated with an anti-CD40 monoclonal antibody, who had been previously exposed to an active form of the disease, but latent tuberculosis (LTBI) was repeatedly ruled out prior to transplantation. To the best of our knowledge, no other case has been reported in a patient treated with the anti-CD40 monoclonal antibody. Case presentation A 49-year-old patient, 1.5 years after primary kidney transplantation, presented with vocal cord problems, a dry irritating cough, and a sore throat. A detailed investigation, including a high-resolution chest CT scan, revealed the diagnosis of disseminated tuberculosis. The antituberculosis treatment consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol was started immediately. The patient's condition became complicated by relapsing diarrhoea. The colonoscopy revealed a circular stenosis above Bauhin’s valve. Microscopical findings showed active colitis and vaguely formed collections of epithelioid macrophages without fully developed caseous granulomas and were consistent with the clinical diagnosis of tuberculosis. The antituberculosis treatment was subsequently enhanced by moxifloxacin and led to a great improvement in the patient’s condition. Conclusion In this case, false negativity of interferon-γ release assays and possibly higher risk for intracellular infections in patients on costimulatory signal blockers are discussed.

Primary Bilateral Tuberculous Otitis Media After Kidney Transplantation: A Case Report

“… 12 As in this case, non-caseous necrosis has been reported in a biopsy of a patient infected with TB after kidney transplantation. 13 One study reported that a patient with human immunodeficiency virus-1 (HIV-1) and pulmonary TB showed the presence of fewer necrotic granulomas and less pulmonary cavitations. 14 On the other hand, completely opposite results have been reported that HIV-1 and TB co-infected patients have more poorly formed and necrotic lymph nodes than HIV-1 negative patients.…”

Concurrent Ocular and Cerebral Toxoplasmosis in a Liver Transplant Patient Treated with Anti-CD40 Monoclonal Antibody

“…Inhibition of the CD40/CD154 pathway may therefore potentiate the reactivation of latent cysts in cerebral and ocular tissue with consequent parasite proliferation and tissue damage. The role of the CD40/CD154 pathway in eliciting cell-mediated immunity in the defense against intracellular infection has also been demonstrated by a case of latent tuberculosis reactivation in a renal transplant patient on iscalimab [ 11 ]. This patient's age and recent systemic corticosteroids and mycophenolate mofetil are also likely to have contributed to his immunodeficient state.…”