title: Concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant: a case report.
abstract: BACKGROUND
  Tuberculosis is still a serious infection among recipients of renal transplants. Although the ileocecal region is the most affected part in intestinal tuberculosis, acute tuberculous appendicitis is quite a rare entity. We report a case of concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant.
  
  
  METHODS
  A 27-year-old Iranian woman, who had been the recipient of a renal transplant five years earlier, presented with a two-week history of coughing, fever and weight loss. The cause of her end-stage renal disease was chronic pyelonephritis. There were fine crackles noted during a chest examination, and a plain chest radiography showed fine miliary nodules throughout her entire lung fields. Sputum and bronchial aspirate examination was positive for acid-fast bacilli, suggestive of Mycobacterium tuberculosis infection. A chest computed tomography scan revealed widespread miliary nodules, compatible with miliary tuberculosis. She developed severe abdominal pain and abdominal surgery disclosed a perforated appendicitis. Histopathological examination of the resected appendix revealed widespread caseating epithelioid granulomas, suggestive of tuberculosis.
  
  
  CONCLUSIONS
  Our case report highlights a rare presentation of tuberculosis in a patient who has undergone renal transplant. Such unusual presentation of tuberculosis, particularly among patients receiving potent immunosuppressive protocols, should be considered by clinicians.
authors: Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. kghabili@gmail.com.
authors: Mohammad R
authors: MR
authors: Ardalan
authors: Mohammadali M
authors: MM
authors: Shoja
authors: Kamyar
authors: K
authors: Ghabili
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