Sasi Sreethish, Varghese Manoj K, Nair Arun P, Hashim Samar, Al Maslamani Muna
Internal Medicine, Hamad Medical Corporation, Doha, QAT.
Infectious Diseases, Hamad Medical Corporation, Doha, QAT.
Cureus. 2020 Nov 23;12(11):e11661. doi: 10.7759/cureus.11661.
Tuberculosis (TB) is a common post-transplant infection with high prevalence in developing countries due to reactivation. Post-transplant TB involves the respiratory system in 50% of patients, followed by disseminated involvement in 30%. The risk of tuberculosis of renal allograft post-transplantation is determined by disease endemicity in the donor population and the immunosuppressant regimen. TB can cause allograft rejection and graft loss due to delayed diagnosis or reduced immunosuppressant drug efficacy. A 23-year-old lady was seen 40 days after cadaveric unrelated renal transplantation from China. She was on immunosuppression with tacrolimus, mycophenolate, and prednisolone. Examination showed low-grade fever and infected surgical site in the right iliac fossa draining pus. Imaging showed fluid pockets, parenchymal micro-abscesses, and perinephric collections in the right iliac fossa communicating with skin. A diagnosis of renal allograft TB without dissemination was made after TB polymerase chain reaction (PCR) from early morning urine was positive. She was started on anti-TB therapy. The sinus tract healed, and renal parameters improved after six months of therapy. Follow-up magnetic resonance imaging (MRI) showed resolution of the micro-abscesses as well as the surrounding fluid collection. Renal angiogram demonstrated well-perfused, normally functioning, non-obstructed renal transplant. Tuberculosis of renal allograft should be considered in a transplant recipient with pyrexia of unknown origin and persistent discharge from the surgical site, not responding to antimicrobials. Tuberculosis of transplant kidney can cause graft loss due to allograft rejection when there is a delayed diagnosis, or as anti-TB drugs reduce the efficacy of immunosuppressant medications. The index of suspicion should be high when donor status is unknown or if the donor is from an endemic tuberculosis area. Timely diagnosis and treatment helped to save the transplanted kidney of our patient without rejection.
结核病（TB）是一种常见的移植后感染，在发展中国家因再激活而具有较高的患病率。移植后结核病在50%的患者中累及呼吸系统，其次是30%的患者发生播散性累及。肾移植后肾移植受者发生结核病的风险取决于供体人群中的疾病流行情况和免疫抑制方案。由于诊断延迟或免疫抑制药物疗效降低，结核病可导致移植肾排斥和移植肾丢失。一名23岁女性在接受来自中国的尸体非亲属肾移植40天后就诊。她正在接受他克莫司、霉酚酸酯和泼尼松龙的免疫抑制治疗。检查发现低热，右髂窝手术部位感染并有脓液引流。影像学检查显示右髂窝有液性腔隙、实质微脓肿和肾周积液，与皮肤相通。清晨尿液结核聚合酶链反应（PCR）呈阳性后，诊断为无播散的肾移植结核。她开始接受抗结核治疗。治疗6个月后，窦道愈合，肾功能指标改善。随访磁共振成像（MRI）显示微脓肿以及周围积液消失。肾血管造影显示移植肾灌注良好、功能正常、无梗阻。对于不明原因发热且手术部位持续有分泌物、对抗菌药物无反应的移植受者，应考虑肾移植结核。当诊断延迟时，移植肾结核可因移植肾排斥导致移植肾丢失，或者由于抗结核药物降低免疫抑制药物的疗效。当供体状态不明或供体来自结核病流行地区时，怀疑指数应较高。及时的诊断和治疗有助于挽救我们患者的移植肾而不发生排斥反应。
