Introduction:
In developing countries, tuberculosis (TB) continues to be a widespread mycobacterial infection, posing a significant health challenge, especially among individuals who have received solid organ transplants. These patients are at an increased risk of TB compared to the general population due to their immunocompromised status. Here, we examine a case involving a 30-year-old woman who had undergone a deceased donor renal transplant five years prior and presented with fever, shortness of breath, and generalized swelling (anasarca).
Methods:
Upon detailed clinical evaluation, patient was found to have azotemia, and chest imaging indicated fluid overload suggestive of a possible heart failure or pulmonary edema. Urinalysis revealed the presence of pus cells and proteinuria, though cultures did not show any bacterial growth. Initially, the clinical presentation led us to suspicion of graft rejection, a common complication in transplant recipients. However, further diagnostic efforts were undertaken due to the atypical presentation. So graft kidney biopsy was performed for confirmation of diagnosis.
Results:
Interestingly graft biopsy revealed presence of caseating granulomas which was an indication of possible tubercular etiology rather than rejection. Subsequent investigations were done including HRCT chest which showed multiple well defined centrilobular nodules of varying sizes (1-4 mm) diffusely involving bilateral lung lobes in central and peripheral fields along with multiple subcentimetric lymph nodes in paratracheal prevascular and subcarinal region, features suggestive of miliary tuberculosis. Diagnosis of disseminated tuberculosis was made. In this case it manifested as miliary tuberculosis a severe form of TB characterized by a wide dissemination of tiny nodules throughout the lung fields. The patient was promptly started on anti-tubercular therapy, which led to significant symptomatic relief, with partial recovery of renal function. Graft kidney was preserved due to early diagnosis and immediate intervention.
Conclusions:
This case underscores the importance of considering renal tuberculosis as a differential diagnosis in transplant patients who present with symptoms that might initially be indicative of rejection. This case highlights the need for vigilance in monitoring transplant recipients for potential infections and underscores the complexities involved in distinguishing between rejection and infectious processes in these patients.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.