title: Transplanted lungs and the "white plague": A case-report and review of the literature.
abstract: BACKGROUND
  Solid organ transplant recipients, especially after lung transplantation, are at increased risk for Mycobacterium tuberculosis pulmonary tuberculosis due to lifelong immunosuppression.
  
  
  METHODS
  A 41-year-old woman underwent a second bilateral lung transplantation that was complicated by fatal pulmonary tuberculosis.
  
  
  METHODS
  Histological examination of a lung biopsy performed 6 weeks after retransplantation revealed a caseating granuloma and necrosis. Acid-fast bacilli were identified as rifampicin-susceptible M. tuberculosis by real-time polymerase chain reaction (PCR), confirmed by culture 2 weeks later.
  
  
  METHODS
  Our investigation led us to highly suspect that the transplanted lungs were the source of M. tuberculosis transmission.
  
  
  CONCLUSIONS
  In order to optimize diagnosis and treatment for lung recipients with latent or active tuberculosis, regular assessment of lower respiratory samples for M. tuberculosis, particularly during the 12-month period posttransplant should be implemented. Regarding donor-derived transmission, screening donor grafts with latent tuberculosis by M. tuberculosis real-time PCR in lymphoid and adipose tissues is an option that should be considered.
authors.affiliation: Aix Marseille Univ, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Marseille APHM, Service de Pneumologie, Equipe de Transplantation pulmonaire APHM, Service d'Anatomo-Pathologie APHM, Service de Chirurgie Thoracique, Equipe de Transplantation pulmonaire APHM, Service de Réanimation Détresses Respiratoires et Infections Sévères, Hôpital Nord, Marseille, France.
authors.forename: Nadim
authors.initials: N
authors.lastname: Cassir
authors.forename: Robin
authors.initials: R
authors.lastname: Delacroix
authors.forename: Carine
authors.initials: C
authors.lastname: Gomez
authors.forename: Véronique
authors.initials: V
authors.lastname: Secq
authors.forename: Martine
authors.initials: M
authors.lastname: Reynaud-Gaubert
authors.forename: Pascal-Alexandre
authors.initials: PA
authors.lastname: Thomas
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
authors.forename: Michel
authors.initials: M
authors.lastname: Drancourt
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000601:surgery; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000209:etiology*