Cerebral Tuberculoma 11 Years after Renal Transplantation

Abstract

A case of cerebral tuberculoma in a 39-year-old patient who had received a renal graft from a living related donor 11 years previously is reported. The patient had a major seizure, progressive psychiatric signs and fever 5 days prior to admission. The clinical history suggested a neurological cause and rapid diagnosis of a cerebral tuberculoma was made by a computed tomography-guided stereotactic puncture of a space-occupying cerebral lesion. The aspirated pus contained Mycobacterium tuberculosis. Anti-tuberculous therapy with isoniacid, rifampicin, ethambutol and pyracinamide was administered. Transplant function deteriorated and the patient died due to intractable septicemia with multiorgan failure from pulmonary infection dissemination and additional urinary tract infection with atypical mycobacteria. The chance for a benign clinical course necessitates vigorous procedures for an early diagnosis of cerebral infections in renal transplant recipients with neurological/psychiatric signs.

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),…”

Identification of genes involved in epithelial-mesenchymal transition and tumor progression

“…They also expressed low levels of the adult kidney-speci®c genes alkaline phosphatase and podocalyxin. They did not exhibit detectable levels of WT1 or PAX2, the embryonic kidney markers, which are also involved in tumorigenic transformation (Mrowka and Schedl, 2000;Eccles, 1998). A low level of the mesenchymal marker FSP1 (®broblast speci®c protein 1), which has been implicated in EMT (Strutz et al, 1995;Okada et al, 1997), could be detected.…”

Changes in WT1 splicing are associated with a specific gene expression profile in Wilms' tumour

“…The WT1 gene, located at 11p13, encodes a zinc finger transcription factor involved in renal and gonad development (Hastie, 2001;Mrowka and Schedl, 2000). Two alternative splicing sites give rise to four major isoforms.…”