title: A case of cerebral tuberculosis after liver transplant and literature review.
abstract: The risk of active tuberculosis is high in solid-organ recipients. We evaluated the clinical presentation of tuberculosis. Pulmonary locations were the most frequent, and extrapulmonary locations were rarely seen. Among extrapulmonary sites, intracranial tuberculosis is rare, with a few case reports reported in the literature. We report a case of 27-year-old man, who received deceased-donor liver transplant due to hepatitis B virus-related chronic liver failure. One month after the liver transplant, neurologic symptoms developed, then he had attacks of tonic-clonic convulsions. Cerebral stereotactic needle biopsy of left temporal lobe was performed. Histopathologically gliosis, rare lymphocyte infiltration, and epithelioid histiocytes were seen. Histochemical staining by Ziehl-Neelsen stain noted acid-fast resistant bacillus. The case was diagnosed as granulomatous inflammation which led to tuberculosis. In addition to antituberculosis therapy, he was given antiviral therapy for prophylaxis. During therapy, reactivation of hepatitis B virus was noted, and the recurrent diseases of hepatitis B virus-related viral hepatitis was diagnosed on serial biopsies. Ten months after transplant, he died from liver failure. Tuberculosis is a serious opportunistic infection in transplant recipients. The incidence of Mycobacterium tuberculosis infection in organ transplant recipients worldwide ranges from 0.35% to 15%. In nonrenal transplant, rejection within 6 months before the onset of tuberculosis and type of primary immunosuppressive regimen were predictors of tuberculosis infection occurring 12 months after transplant. The diagnosis and effective management of tuberculosis after transplant warnings recognition of the epidemiologic and clinical characteristics of tuberculosis in transplant recipients.
authors.affiliation: Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: M Zeyneb
authors.initials: MZ
authors.lastname: Tunca
authors.forename: Eda
authors.initials: E
authors.lastname: Yılmaz Akçay
authors.forename: Gökhan
authors.initials: G
authors.lastname: Moray
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Özen
authors.forename: B Handan
authors.initials: BH
authors.lastname: Özdemir
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D017809:Fatal Outcome; D006515:Hepatitis B virus / Q000187:drug effects / Q000472:pathogenicity; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D016862:Tuberculoma, Intracranial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014775:Virus Activation
chemical_list: D000995:Antitubercular Agents; D000998:Antiviral Agents