Renal allograft tuberculosis: report of three cases and review of literature.
Renal transplant recipients are prone to a variety of infections due a persistent immunodepleted state. Incidence of tuberculosis in this population is much higher compared with the general population. While pulmonary tuberculosis still remains the commonest form in this population, renal allograft tuberculosis is very rare. We report two cases of isolated allograft tuberculosis and one case of allograft tuberculosis with coexistent pleuro-pulmonary and bone marrow involvement. All three cases had presented with pyrexia of unknown origin, wherein despite extensive investigations the cause was not found. In two cases the diagnosis was confirmed on histology. Two cases responded to non-rifampicin-based modified antitubercular treatment and one to conventional four-drug Rifampicin-based regimen. Graft function improved in two cases while in one case the graft was lost. Tuberculosis involving the renal allograft is a potential cause for graft dysfunction/loss and requires a high index of suspicion for diagnosis. Timely detection and early institution of therapy can help save the renal allograft.
Khaira
Ambar
A
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
Bagchi
Soumita
S
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
Sharma
Alok
A
Department of Pathology, 1st Floor Teaching Block, All India Institute of Medical Sciences, New Delhi, 110029, India. dr_aalok@yahoo.com.
Mukund
Amar
A
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Mahajan
Sandeep
S
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
Bhowmik
Dipankar
D
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
Dinda
Amit K
AK
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
Agarwal
Sanjay K
SK
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
D000328:Adult; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D001706:Biopsy; D001853:Bone Marrow / Q000382:microbiology / Q000473:pathology; D004359:Drug Therapy, Combination; D005260:Female; D005335:Fever of Unknown Origin / Q000382:microbiology; D006084:Graft Rejection / Q000382:microbiology* / Q000473:pathology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012293:Rifampin / Q000627:therapeutic use; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014396:Tuberculosis, Pleural / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014398:Tuberculosis, Renal / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D018615:Ultrasonography, Doppler, Color
D000904:Antibiotics, Antitubercular; D007166:Immunosuppressive Agents; D012293:Rifampin