title: Renal allograft tuberculosis: report of three cases and review of literature.
abstract: 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.
authors.affiliation: Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ambar
authors.initials: A
authors.lastname: Khaira
authors.affiliation: Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Soumita
authors.initials: S
authors.lastname: Bagchi
authors.affiliation: Department of Pathology, 1st Floor Teaching Block, All India Institute of Medical Sciences, New Delhi, 110029, India. dr_aalok@yahoo.com.
authors.forename: Alok
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Amar
authors.initials: A
authors.lastname: Mukund
authors.affiliation: Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mahajan
authors.affiliation: Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Dipankar
authors.initials: D
authors.lastname: Bhowmik
authors.affiliation: Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Dinda
authors.affiliation: Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Agarwal
mesh_terms: 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
chemical_list: D000904:Antibiotics, Antitubercular; D007166:Immunosuppressive Agents; D012293:Rifampin