A Case Series of Gastrointestinal Tuberculosis in Renal Transplant Patients

Abstract

Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach.

Mycobacterium tuberculosisafter solid organ transplantation: A review of more than 2000 cases

“…During the period from 1998 to 2016, a total of 187 studies reported 2082 cases of TB after SOT . The majority (135/187 [72.19%]) were case reports or series, while the remainder were retrospective studies (n = 43),…”

Gastrointestinal tuberculosis following renal transplantation accompanied with septic shock and acute respiratory distress syndrome: a survival case presentation

“…Rifampicin is a strong inducer of microsomal enzyme P450 3A4, which leads to increased metabolism of calcineurin-inhibitors, rapamycin and steroids [ 24 ]. Rifampicin reduces plasma levels of cyclosporine 2-5 fold and tacrolimus 4-10 fold [ 1 ], which increases the risk of rejection [ 13 ]. Moreover, common TB medications may lead to interactions with other required drugs, as documented with our case.…”

Tuberculous enteritis: a surgical ‘Janus’ masquerading as intestinal obstruction

“…Lungs are commonly involved. In renal transplant (RT) recipients, extrapulmonary (occurring in 15%) and disseminated diseases (33-49%) are very frequent [1], while intestinal involvement is extremely rare, with a reported prevalence between 0.2% and 0.6% [2]. Atypical presentation is the rule in immunocompromised patients, while high clinical suspicion is required.…”

“…Gastrointestinal manifestation is infrequent, but potentially lethal. It appears frequently during the early PT period [1]. Commonly, it is presented with atypical and vague symptoms such as abdominal pain, fever, weight loss.…”

“…In immunosuppressed patients, TB is frequent, rapidly disseminates and appropriate therapy should be instituted as early as possible when there is a high degree of suspicion even in the absence of MT isolation [2]. PT-TB poses high mortality which is mostly related to co-existing infections and side effects of anti-TB treatment, mainly hepatic failure [4], while GITBassociated mortality varies between 20% and 30% and must always be taken into account when treating RT patients [1].…”