Tuberculosis in a renal allograft recipient presenting with intussusception

Abstract

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.

Infections After Kidney Transplantation: The Bug Bear Of Kidney Transplantation In Tropics

“…10-20% of patients present with pyrexia of unknown origin [29]. Organ involvement is similar to that seen in general population, though rare manifestations (such as intussusception) are possible [32].…”

Mycobacterium tuberculosisafter solid organ transplantation: A review of more than 2000 cases

“…During the period from 1998 to 2016, a total of 187 studies reported 2082 cases of TB after SOT . The majority (135/187 [72.19%]) were case reports or series, while the remainder were retrospective studies (n = 43),…”

Immune Reconstitution Inflammatory Syndrome Occurring in a Kidney Transplant Patient with Extrapulmonary Tuberculosis

“…IRIS has recently been described with increasing frequency in SOT recipients who are undergoing treatment for TB and other opportunistic infections who have necessarily had to have their immunosuppression curtailed [ 9 , 10 , 14 ]. Review of the literature documenting IRIS in SOT has revealed 3 case reports and 1 retrospective study documenting 9 cases, which include 6 liver, 4 kidney, 1 heart, and 1 heart lung transplant [ 10 , 14 – 16 ].…”