Case Report: Disseminated Tuberculosis After Kidney Transplantation

Abstract

Tuberculosis (TB) can cause significant morbidity and mortality among solid organ transplant (SOT) recipients, including disseminated disease. Most TB cases after SOT occur in kidney transplant recipients, although data about TB in this population are sparse. Tuberculosis may present atypically in immunocompromised patients, underscoring why physicians must maintain high clinical suspicion when pertinent epidemiological risk factors are present, including birth or former residence in a country with endemic TB. We describe a unique case of disseminated TB in a 54-year-old Filipino woman who developed central nervous system tuberculoma, Pott's disease, chorioretinitis, and a perinephric fluid collection after kidney transplantation. Despite being a preventable and curable disease, TB remains a relevant and challenging infection with complex diagnostic and treatment guidelines.

Figure 1.

Chest X-ray 4 months prior to kidney transplantation showing a new left-sided pleural effusion with secondary atelectasis.

Figure 2.

Computed tomography of the abdomen and pelvis showing a right lower-quadrant renal transplant with lobulated perigraft collection measuring 8.1 × 3.2 × 14.5 cm with mild mass effect on the transplanted kidney.

Figure 3.

T1 postcontrast magnetic resonance imaging of the brain demonstrating a 3-cm right occipital ring-enhancing lesion, later found to be a central nervous system tuberculoma.

Figure 4.

T1 postcontrast magnetic resonance imaging of the thoracic spine demonstrating innumerable contrast-enhancing lesions in the vertebral bodies, consistent with Pott’s disease.