J Korean Soc Transplant.  1999 Dec;13(2):345-347.

Tuberculous Abscess of the Graft in a Renal Transplant Recipient after Chronic Rejection

• Choi IS
• Park JB
• Kim SJ
• Joh JW
• Lee SK
• Huh WS
• Oh HY
• Kim SM
• Peck KR
• Song JH
• Lee BB

Abstract

Tuberculosis is a significant opportunistic infection in transplant recipients under the immunosuppressed condition, though not common and also known to have higher incidence among transplant recipients than in general population. The most common form of tuberculosis among transplant recipients is pulmonary, gastrointestinal, bone and genital tract in decreasing order. However tuberculous infection of the transplanted graft is rare and usually associated with disseminated tuberculosis with high mortality. We experienced M.. tuberculosis infection of the renal allograft after chronic rejection. A 28-year-old female received living-related renal transplantation, required high-dose steroid therapy for two episodes of acute rejection (8 and 20 months later). However, she eventually became renal failure due to chronic rejection and immunosuppression therapy was discontinued. Patient was refered back to our institute for the hemodialysis (post-transplant 40 months) when the patient was found to have pulomary tuberculosis of miliary type. Antituberculosis medication (INH, RFP, EMB & PZA) was immediately started on the basis of positive cultures from lung and bone marrow specimen for M. tuberculosis. In spite of full medication, high fever was sustained and subsequently pyonephritis of grafted kidney was detected and infected graft was removed to confirm the tuberculosis is very serious disease among immunosuppressed transplant patient and therefore more aggressive approach is needed including the search for the hidden infection even at the failed graft with cessated function

Keyword

Renal transplantation; Tuberculous abscess

MeSH Terms

Abscess*
Adult
Allografts
Bone Marrow
Female
Fever
Humans
Immunosuppression
Incidence
Kidney
Kidney Transplantation
Lung
Mortality
Opportunistic Infections
Renal Dialysis
Renal Insufficiency
Transplantation*
Transplants*
Tuberculosis