Mohapatra A, Basu G, Sen I, Asirvatham R, Michael J S, Pulimood A B, John G T
Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Nephrol. 2012 Jan;22(1):52-6. doi: 10.4103/0971-4065.83741.
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 11(th) 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.
肺外结核在肾移植受者中更为常见，可能表现为播散性或非典型特征。我们报告一例肾移植受者，在移植后3年出现肠结核，表现为持续发热、体重减轻、腹泻、腹痛以及腹部肿块伴肠梗阻。他被诊断为回结肠套叠，切除术后显示为肉芽肿性炎症，存在典型的结核分枝杆菌抗酸杆菌（AFB）。此外，气管吸出物中检测到AFB，提示播散。他从术后第4天开始接受抗结核治疗（ATT）。然而，他出现了可能的免疫重建炎症综合征（IRIS）并伴有多器官功能衰竭，于术后第11天死亡。这是首例肾移植受者中肠结核表现为套叠的报告。肾移植受者开始接受ATT后发生IRIS的情况很少见。本报告强调了在肾移植受者中早期诊断结核需要高度怀疑指数，以及在感染严重且开始ATT后因免疫抑制降低而出现IRIS时的治疗困境。
