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

Abstract

BackgroundPost-transplant tuberculosis (PTTB) is a serious opportunistic infection in renal graft recipients with a 30-70 fold higher incidence compared to the general population. PTTB occurs most frequently within the first years after transplantation, manifesting as pulmonary or disseminated TB. Gastrointestinal TB (GITB) is a rare and potentially lethal manifestation of PTTB and may show delayed onset in renal transplant recipients due to the use of lower doses of immunosuppressants. Further, non-specificity of symptoms and the common occurrence of GI disorders in transplant recipients may delay diagnosis of GITB.Case presentationHere we report a rare survival case of isolated GITB in a renal transplant recipient, occurring seven years after transplantation. The patient’s condition was complicated by severe sepsis with positive blood culture Staphylococcus haemolyticus, septic shock, multiple organ failure including acute respiratory distress syndrome (ARDS) and acute renal failure, requiring mechanical ventilation, vasopressor circulatory support and intermittent hemodialysis. Furthermore, nosocomial infections such as invasive aspergillosis and Pseudomonas aeruginosa occurred during hospitalization. Antituberculosis therapy (rifampicin, isoniazid, ethambutol and pyrazinamide) was initiated upon Mycobacterium confirmation. Moreover, treatment with voriconazole due to the Aspergillus flavus and meropenem due to the Pseudomonas aeruginosa was initiated, the former necessitating discontinuation of rifampicin. After 34 days, the patient was weaned from mechanical ventilation and was discharged to the pulmonary ward, followed by complete recovery.ConclusionThis case offers a guideline for the clinical management towards survival of GITB in transplant patients, complicated by septic shock and multiple organ failure, including acute renal injury and ARDS.

"Late Infectious Complications in Solid Organ Transplant: Disseminated Aspergillosis and Pulmonary Tuberculosis in a Patient with Kidney Transplant"

“…Infections remain one of the main complications after kidney transplantation, along with cardiovascular and neoplasic disease [1][2][3][4]. Anti-rejection immunosuppressive management composed of a calcineurin inhibitor, antimetabolite and steroid interfere with the normal function of neutrophils and immune responses mediated by T and B cells, increasing the risk of viral, fungal and bacterial infections in the patient with kidney transplant [2,5].…”

“…In the early period, nosocomial infections stand out, those derived from the donor or the recipient. In the period when immunosuppression levels are at its highest (31 days to 1 year) there is a greater risk of opportunistic infections, some may be susceptible to prophylaxis treatment according to the infectious risk; and in the late period (>1 year) infections acquired in the community stand out, without ruling out endemic and opportunistic microorganisms [1,3,6,7]. Tuberculosis represents a potentially fatal infectious complication in immunosuppressed patients.…”

miR-146b-3p regulates PI3K/AKT signaling pathway in septic mice with acute respiratory distress syndrome

“…ARDS is a life-threatening complication featured by diffuse alveolar damage [22]. The incidence of ARDS varies widely, ranging from 1.5 patients per 100,000 people to nearly 79 patients per 100,000 people; European countries report lower incidence than the United States; mortality also varies due to the severity, age, and underlying medical conditions [23][24][25][26][27]. No monotherapy has been found to alter the latent pathological process of ARDS to date.…”

“…As a complex pathological process, ARDS is regulated by transcription factors as well as miRNA. A miRNA is a small endogenous non-coding RNA molecule that includes approximately [18][19][20][21][22][23][24] nucleotides. It usually complements sites in the 3' untranslated region of the target messenger RNA for inhibiting the expression of post-transcriptional gene [8].…”

Effect of replacement therapy (CRRT) and hemodialysis (IHD) on severe acute renal failure

“…Early diagnosis and timely rescue are essential to reduce mortality, improve prognosis and restore renal function. Due to the wide variety of pathogenic factors of severe acute renal failure, the clinical manifestations of different patients are different, the clinical diagnosis and treatment plan are difficult to determine, and the prognosis of patients with different treatment plans is different (Cikova et al, 2017). On the basis of common treatments such as correction of water-electrolyte and acid-base balance disorders, anti-infection, nutritional support, etc., specific treatment plans and strengths need to be determined according to the etiology, combined with the diagnosis and the nature of the disease.…”