Disseminated Tuberculosis Following Renal Transplant: A Case Report

Author(s): Omar Faroque, Abdur Rahaman, Muhammad Nazrul Islam, Rana Mokarram, Sayed Fazlul Islam, Nourin Sultana, Sarwar Iqbal.

Tuberculosis is a great challenge for post-transplant patients. The burden is more complicated in developing countries like Bangladesh. It can cause allograft rejection and graft loss due to delayed diagnosis or loss of efficacy of immunosuppressant drugs following anti-tubercular therapy. The present study documents a case where a patient developed disseminated tuberculosis after receiving a kidney transplant. This article presents the case of a 58-year-old woman who had a renal transplant 10 years back and presented with fever for 2 months. Detailed history and examination shows there is nodular swelling in the left post auricular area along with multiple swelling in the scalp. There was tenderness in the right hypochondriac area. Thorough investigations including a CT scan of the abdomen were done which showed a collection of pus in the subphrenic area. Ultrasound guided aspiration of the pus was done and was sent for microbiological evaluation. FNAC was done from the left post auricular swelling and was sent for microbiological evaluation. Both of the samples were positive for tubercular bacilli. Urine GeneXpert was also positive for AFB. The patient was diagnosed as a case of disseminated tuberculosis and an antitubercular regimen was started. After the treatment patient was clinically improved. The index of suspicion should be high when a posttransplant patient presents with PUO. Early diagnosis may save the graft function